Villacourt Rovers Football Club

Membership Form

Instructions
Please enter the fields below. Those marked in orange are mandatory.
Player's Name
Full Name of Player
Team
Home Address
Postcode
Home Telephone Number
Primary Mobile Number
Please enter the most appropriate mobile number to get hold of you at short notice (e.g. for match cancellation).
Email Address
Please enter your primary email address we can use to send you team or club information. By entering your email address you are agreeing to receive club information via email.
Date of Birth
Medical Details
Please indicate if the player has any medical conditions or allergies that we should be aware of.
Parent/Carer First Name
Parent/Carer Surname
Parent/Carer Home Telephone Number
Please enter home telephone number if different from above
Parent/Carer Mobile Number
Please enter the mobile number if different from above
Parent/Carer Relationship
e.g. Father, Mother
Emergency Contact #1 Name
Please enter the name of someone we can contact in an emergency if the above named person can not be reached.
Emergency Contact #1 Telephone
Emergency Contact #2 Name
Emergency Contact #2 Telephone