Development Day (Disability Football)

Manchester Football Association
Talent Identification Programme (Disability)

Thank you for your interest in attending our Disability Football Development Day on Saturday 17th March

Please complete and submit the short enrolment form below and a member of the team will be in touch with further details.

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* 1. Enter Player Details:

Player Firstname

Player Surname

Place of Birth

Date of Birth

Age

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* 2. Address:

First Line

Second Line

Third Line

Post Code

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* 3. Name & Address of School/College:

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* 4. Team/s:

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* 5. Disability:

Cerebral Palsy

Partially Sighted

Deaf/Hearing Impaired

Amputee

Blind

Comments

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* 6. Other medical conditions/allergies we should be aware of:

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* 7. Parent/Guardian's Personal Details:

Title

Firstname

Surname

Email Address

Address Line 1

Address Line 2

Address Line 3

Post Code

Mobile Number

Emergency Phone Number

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* 8. How did you hear about this opportunity?

School

Football Club

Poster

Friend

Website/Social Media

Other (please specify)

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* 9. At this event we may wish to take photos and videos of the individuals taking part on the day. As a County FA we adhere to FA guidelines to ensure all content taken is in a safe and respectful manner and used solely for the purposes for which they are intended, which is promotion and celebration of the event.

Please indicate if this is acceptable and you give photo/video consent.

Yes

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* 10. I give consent for my son/daughter to participate in the development day.

Yes

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* 11. Signed (legal carer)

Please print name

Date