registration – Chesterfield Junior Blues FC

Player Registration Form season 2023-24

ALL players are required to provide a head/shoulders photograph. NEW players are also required to provide suitable ID for league registration. We accept a photo or scan of either Passport or Birth Certificate which must be uploaded below.

Players are not insured to play for CJBFC or to receive a playing kit until an initial payment is made.

Once a player is successfully registered to the club and the FA we delete all stored ID image files.

Team Name

Player First Name

Player Surname

Player Date of Birth (DD/MM/YYYY)

Any Medical Conditions that we should be aware of

Parent/Guardian Name (if under 18)

Parent/Guardian Email

Parent/Guardian Phone

Parent/Guardian Date of Birth *(DD/MM/YYYY)

Address Line 1

Address Line 2

Town

Postcode

Player PHOTO

Player ID (Birth Certificate or Passport)

Parental / Guardian Consent

I consent to my son/daughter being photographed and/or filmed at CJBFC events, training and matches, or when representing CJBFC, for example at Tournaments, and for pictures to be published by CJBFC, their sponsors, the FA and the press.

In the event that my son/daughter is injured whilst playing football/travelling to and from events, and I cannot be contacted, I agree to my child receiving medical treatment.

I understand that I must keep up with my subscriptions and that failure to do so could mean my son/daughter will not be able to play in matches.

If subscriptions are not paid in full, or monthly payments are not up to date, then players will not be allowed to play in further matches, sign for the following season or receive an end of season trophy.

Playing kit remains the property of CJBFC and must be returned to the club in the event of my child leaving before the end of the 2 year kit lifetime.

By submitting this form I and my son/daughter agree to abide by the CJBFC codes of conduct and other rules and policies set out by CJBFC which meet the requirements of the FA‘s Respect Campaign (cjbfc.uk/resources).

* Date of birth is included so that The Football Association or a County FA can verify the identity of the person who is associated with the youth record, which is essential for maintaining the security of the player data held.

If an email address or a telephone number is provided this will be stored against the record for the Parent/Guardian, and not against the player.