Player Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I can confirm that my son/daughter currently receives free schools and is eligible for the HAF programme *

Yes

Which date/s would you like to sign up for? *

(please make a note/remember which days you have signed up for as you will not be able to attend any dates you have not registered for)

Full Camp! (Tuesday 2nd to Friday 5th April)

Tuesday 2nd April

Wednesday 3rd April

Thursday 4th April

Friday 5th April

Is the player from a Ukrainian refugee family *

Yes

No

Media Consent *

This is to certify that I have no objections to Worksop Town Academy or associated company using any photographic or video images of my child whilst attending a Worksop Town Academy event. Any images will only be used to promote the work of Worksop Town Adacemy/FC to partners and funders along with local, national and social media outlets.

I agree

I do not agree

Parent/Guardian Consent *

We are committed through trained and competent staff to providing a safe learning environment, however football is a contact sport and injuries may occur through no negligence of our staff. We feel it is our responsibility to ensure the safety of the attendee by making sure they come well equipped for the activity i.e. correct footwear, appropriate clothing, food/drinks if appropriate, medication (if applicable). I have read and understood this form, completed all the details requested to the best of my knowledge and will comply with the information set out. I acknowledge and accept that Worksop Town Academy or respective servants shall not have any liability in respect with any loss or damage to property and give permission for my child to receive emergency medical treatment in my absence if deemed necessary.

I agree