Football Registration – Ocean Youth Connexions

Young Person Details

Section 1: Details of young person enrolling.

First Name *

Last Name *

Date of Birth *

Ethnicity

Contact Number

Email Address

Email

Confirm Email

Current School / College *

Year group *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency contact details of Parent / Guardian

Section 2: Details of legal Parent / Guardian of young person

First Name *

Last Name

Contact Number *

Email Address

Email

Confirm Email

Relationship to young person

Does your child have any medical or mitigating circumstances? *

Yes
No

i.e. Special Needs, Requires Medication / has any Medical conditions. Allergens or any other relevant information we need to know to support your child?

Please provide further details of any medical or mitigating circumstances:

Open Access Youth Club Sessions

Weekend football
Media consent

Legal Parent / Guardian Consent

This is to be only completed and submitted by the Parent or Guardian named in section 2.

I am the legal Parent / Guardian for the young person named under section 2 above. I consent for the named young person to take part in (but not limited to) the activities described above provided by OYC Ocean Youth Connexions. I also consent for the named young person in section 2 above to be given first aid or urgent medical treatment during any trip or activity. *

I confirm