PLAYER REGISTRATION

PLAYER DETAILS

Team Name:

 D          D           M        M           Y          Y          Y          Y

Under 7

Under 9

Under 8

Child’s Name

Parent’s Name

Date of Birth

Address

Town

Postcode

County

Name of Parent

Signed by Parent

Date

E-mail

Phone

League Category:

DECLARATION

Please sign and complete the boxes below to confirm: 

You are the parent or legal guardian of the child named above, and that you have read and signed the code of conduct 

and disclaimer.

Under 11

Under 10

Under 12

Lancashire Junior Soccer Leagues. Company Reg No. 10055853 

40 Queen St, Great Harwood, Blackburn, Lancs, BB6 7QQ

TEAM DETAILS

Emergency Phone