Interested in taking part ?

Before completing your registration form please have a read through the rules of play section, you will be asked to confirm you have read and understand these prior to submitting the form below.

Please click here to view

Rules of Play

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Please take a moment to fill out the form.

First Name

Last Name

Date of Birth required

Phone

Street Address

Town / City

Postcode

Emergency Contact / Relationship

Emergency Contact Tel

Health Details - Do you have a disability or injury that may prevent you participating actively in the practical session? Required

Yes

Do you have a learning difficulty? Required

Yes

If you have answered yes to the above, please give further details and indicate any requirements you have:

Current Health Status Required

Fully Fit

Unsure

Medications / Tablets (currently being taken)

Other information: (please declare any other medical information you feel appropriate

Where did you hear about Walking Football

I confirm i have read the rules of play and will abide by the code of conduct Required

Yes

I confirm that my participation in Walking Football with St Helens WFC is undertaken at my own risk. The Club cannot be held responsible for accidents or illness resulting from taking part. St Helens Walking Football Club formally reserves the right to utilise your likeness on our website for promotional and informational purposes. By participating, you acknowledge and agree to this use. If you have any concerns, please contact us directly Required

Yes

Signature

Thanks for submitting!

ST HELENS WALKING FOOTBALL CLUB

Interested in taking part ?

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