EmailMe Form - Pro Coaching Academy Enrolment Form

Name of preferred Pro Coaching Centre *
Littlehampton
Worthing*
Angmering
*Fit4 membership number
*Only required by our Worthing Customer who are members of South Down Leisure
Player Name *
First Last
Player Date of Birth *
DD / MM / YYYY
Name of School *
Male/Female *
Male
Female
Parent/Guardian Name 1 *
First Last
Parent/Guardian Name 2 *
First Last
Address *

Street Address City State / Province / Region Postal / Zip Code
Mobile Phone (Parent Guardian #1) *
Mobile Phone (Parent Guardian #2) *
Land Line Number *
Alternative Emergency contact number *
For use in rare instances
Email *
Please be sure to send an email to office@procoachingfootballacademy.com doing this ensures that you will receive our important updates.
Your Facebook page address or twitter handle
Please be sure to like our Facebook page and follow us on twitter - the details will follow once you have completed this form.
Preferred method of communication *
Text
Email
Phone
Mail - Snail Mail
How would you like us to contact you? Click as many as you wish.
Preferred method of payments *
Cash
Cheque
Online
Card
Payments are made on a half termly basis and are required before the beginning of each half term.
Player Photo *
Please upload a head and shoulders player photo.
N.B. Only .jpeg / .jpeg / .png files
Photography Permission *
I allow permission for the taking and use of photography
I do not allow permission for the taking and use of photography
Photographs made be used for publicity and marketing purposes. Photos may also be posted on our social media. Photos are also used to create gifts and promotional items exclusively for your to purchase.
Medical Conditions *
Is there anything that we need to know about your player?
Emergency Word / Phrase *
For the times when someone else collects your player/s.
Consent *
BY SIGNING THIS FORM PLAYERS AND PARENTS AGREE TO ABIDE BY THE PCFA/FA CODE OF CONDUCT. I herby authorise Pro Coaching Football Academy to act for me according to their best judgement in any emergency requiring medical attention and release Pro Coaching Football Academy from any and all liability for injury, illness, death or loss whatsoever whilst during an Academy or Holiday session.
Signature *
Clear
Signature of consent
Date *
DD / MM / YYYY
Welcome to Pro Coaching Football Academy we wish you every success on your football journey with us! Please click the button below to submit your form. A verification with pop up after you have clicked with our contact details please keep these for your reference.