Junior Registration Page - Juventus Durban

Hidden

Next Steps: Install the User Registration Add-On

This form requires the Gravity Forms User Registration Add-On. Important: Delete this tip before you publish the form.

Player Contact Details*

First Middle Last

Date Of Birth*

ID Number*

Dad's Name

First Last

Dad's Phone

Mom's Name

First Last

Mom's Phone

Telephone Number

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Enter Email Confirm Email

I can assist the club with the following:

Sponsorship

Coaching

Fundraising

Marketing

Administration

Referee

Child’s relevant medical information including ailments, injuries, medication or allergies:

Medical Aid

Medical Aid member number:

Disclaimer

All club representatives will take as many precautions as possible to ensure that the welfare of the child is always the first priority and whilst every effort has been made to make Juventus Durban FC a safe and welcoming environment we have to make you aware the football is a contact sport and injuries can happen. Juventus Durban FC would like to point out that they are not liable in any way for any injuries to anyone, this includes spectators. Juventus Durban FC does not insure any player against personal injury sustained through playing, training or travelling to or from such activities. It is the responsibility of players or their parents/guardians to arrange any additional insurance against personal injury.

Club played for last season:

Division age group this year:

Important Documents

3 ID photos *

GDLFA Documents *

Indemnity Form *

Code of Conduct

Code Of Conduct Document

I have read and understood the contents of this form and I warrant that all information provided by me is true and correct. I will adhere to the Juventus Durban FC code of conduct.

Date

Name

Mother

Name

Father

Signature

Junior Registration

Price: