Keilor Football Club Junior Registration Form printable pdf download

Keilor Football Club Junior Registration Form

Age Group

Under______

KEILOR FOOTBALL CLUB

JUNIOR REGISTRATION FORM 2017

Player Details:

Player Name: ___________________________________________________

D.O.B______________________ Birth certificate supplied:

Yes

(Circle)

Preferred address for correspondence:

____________________________________________________________________

Home Phone: ______________________Mobile:____________________________

Email Address: _______________________________________________________

Medical History: Please list any medical conditions suffered __________________

____________________________________________________________________

School attended: _____________________________________

Parents Details:

Name (Mother):______________________________

_______________________

Mobile

Name (Father):_____________________________

_______________________

Mobile

Parent/s Occupation/s: _____________________/____________________________

Players and Parents have read and understood the Keilor Football Club Code of

Conduct as printed on the reverse side of this form and are willing to sign and

abide by this mandatory and enforceable code.

Player (signature)______________________________________________

Mother (signature)______________________________________________

Father (signature)_______________________________________________

DATE: ___ /___ / ____

Registration includes Family Membership to the Keilor Sports Club

***Please note – this information is for internal club use only***

Office Use Only

Fees Paid - Yes No

Amount: ___________ Receipt Number: ______________

EDFL Registration Form & B/C Submitted (all new players to KFC only)

YES NO

Keilor Football Club Junior Registration Form