Parental Consent & Registration Form

A Different Way, Instilling a love of sport ensuring life long participation.

Following your child's free tasters we hope that you entrust us with the development of your child, it is a responsibility we do not take lightly. On your child completing their two free taster sessions and you confirming they would like to continue and become a member you will receive an estimate of your monthly fees together with full membership details.

Childs Details

Childs First Name

First Name

Childs Last Name

Last Name

Date of Birth

YYYY

Parent/Carer Details

Parent/Carer Name

First Name

Last Name

Occupation

Mobile telephone number

Home Telephone number

Email Address

Address

House/flat number

Street

Town/City

Post Code

Medical & Emergency Details

Please provide contact details different to those provided above incase we are unable to reach you.

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Mobile Number

Any Medical, Allergies or Special Needs

Any Medication

How did you hear about us? (Please state name if referred by a friend)

Membership Fees

Please tick the monthly fee payment below to confirm you have seen and are happy with this should your child want to continue and become a member following their two free taster sessions, please note this is no obligation.

Monthly Single Session (1 per week): £25.00

Kit Options

Please select the kit option you would like.

Full Kit Junior (Including Shirt, Shorts and Socks): £38.00

Full Kit Adult (Including Shirt, Shorts and Socks): £45.00

Full Kit Junior + Futsal Partnership Ball: £53.00

Full Kit Adult + Futsal Partnership Ball: £60.00

None

Signature

Data Protection: Here at Tyneside Futsal we take your privacy seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us. Please click below for our full Privacy Policy. http://www.thefutsalpartnership.com/privacypolicy-tyneside However, from time to time we would like to contact you with details of other events and offers and with information such as newsletters and company updates. We will never pass your details on to any 3rd parties for marketing purposes. We may also, from time to time take photographs for marketing purposes, by ticking the box below you are providing your consent for us to do so. Safeguarding: It is your responsibility to ensure your child is dropped off and collected safely by a parent or guardian from the coach at any of our events (Sessions/Holiday Weeks etc), we will do our upmost to ensure this.

Signed

I can confirm that I agree with the above terms and conditions and by clicking Submit I am electronically signing the consent form

I agree to the above statement