JPL Midlands Representative Team - Final Trials Registration (2024/25)
If you have any questions or concerns regarding the completion of this form please contact gareth.hamer@junior-premier.co.uk

Final Trial Timings and Dates: 
Sunday 1st September 2024

U9 & U10s : 09:00am till 11:00am
U11 & U12s : 11:00am till 13:00pm
U13 & U14s : 13:00pm till 15:00pm
U15s : 15:00pm till 17:00pm
U16s National Team : 15:00pm till 17:00pm (23/24 Rep Team Players only)

Venue : Brookvale Inner City Academy, Witton Road, Birmingham, B6 7DS

Please only attend your allocated times slot for your age group.

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Email *
Player's First Name *
Player's Surname *
Home Address *
Postcode *
Player's Date of Birth (check format carefully) *
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Next Season's Age Group (from 1st Sept 2024) *
Required
Primary Playing Position *
Required
Secondary Playing Position *
Required
JPL Club (24/25 season) *
Medical conditions / allergies (including any medication) *
Primary Contact: First Name *
Primary Contact: Surname *
Relationship to Player *
Required
Primary Contact: Phone Number *
Primary Contact: Email Address *
Image / Video Consent *
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I understand that I retain the right to withdraw consent at any time and that I will do so by informing the JPL Representative Team in writing. *
Required
I give consent for my son/daughter to participate in the JPL Representative Team’s activities and events and I agree to the conditions outlined on this form. I accept that it is my responsibility to inform the JPL Representative Team directly of any changes to the details recorded on this form.   *
Required
In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number, I hereby give my consent for my child to receive medical attention as necessary. If you have specific consent details/requirements - please select "other" and provide further details. *
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Name of person completing this form and giving the above consent: *
Date of form completion/consent given: *
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A copy of your responses will be emailed to the address you provided.
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