Tondu United FC - Walking Football Registration Form
About You
Full Name *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Gender *
Address Line 1 *
Your answer
Address Line 2
Your answer
Town *
Your answer
Post Code *
Your answer
Email *
Your answer
Mobile Phone number *
Your answer
Home Phone number
Your answer
Your Medical Information
Do you consider yourself to have a disability? *
If yes, what is the nature of your impairment?
Any more information you wish to give? *
Please provide as much information as possible about any medical information that is RELEVANT to the session. (Medication/allergies/dietary requirements etc.) – If you do not have any, please state ‘N/A’
Your answer
Emergency Contact Information
Doctor's Name *
Your answer
Address & Postcode *
Your answer
Telephone Number *
Your answer
Next of Kin 1 - Name *
Your answer
Relationship to you *
Your answer
Contact Number *
Your answer
Disclaimers
Please tick the boxes below to confirm agreement before registering.
I can confirm that I understand the above and that the information I have provided on this form is correct to the very best of my knowledge. I can confirm that I am well & healthy to partake in physical exercise and understand that it is my responsibility to seek the advice and approval of my doctor before undertaking regular exercise. *
I give my consent for photographs and video footage to be taken of myself when participating in Tondu United Football Club sessions and I give my consent for the images/footage to be used for marketing purposes by the club in such places as the club website and social media pages. *
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