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This form should be used if you wish to enrol your
child in the Junior Dragons. You will only need to fill this in once, as they
will remain a member up until the age of 11, at which point, you, as the parent
or guardian, will receive an invitation for them to join the Trusts Youth
membership level. Items marked (*) are REQUIRED. Please ensure that
all information is entered correctly, as this is what will be entered into our
membership database.
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Child's details |
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| First Name (*) |
Please type your
full name. |
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| Surname (*) |
Please type your
full name. |
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| Gender (*) |
Invalid Input |
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| Date of Birth (*) |
Invalid Input -Enter DOB in this format: 00/00/0000 |
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| Favourite Player (*) |
Please type your
full name. |
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| Which school does the child attend? (*) |
Please type your
full name. |
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| Does the child suffer from any illness or learning or physical disabilities which should be brought to our attention? If YES, please give brief details |
Invalid Input |
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| Special dietary requirements (if any) |
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Parent’s / Guardian’s details |
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| Parent\Guardian First Name (*) |
Please type your
full name. |
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| Parent\Guardian Surname (*) |
Please type your surname |
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| Address1 (*) |
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| Address2 |
Invalid Input |
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| Town/City (*) |
Invalid Input |
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| County |
Invalid Input |
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| Postcode (*) |
Please type your
Postcode |
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| Home Contact Number (inc. STD) (*) |
Invalid Input |
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| Work Contact Number (inc. STD) (*) |
Invalid Input |
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| Mobile Contact Number |
Invalid Input |
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| Emergency Contact Number |
Invalid Input |
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| Parent\Guardian E-mail * (*) |
Invalid email address. |
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*We can now only confirm places via email, so you will need to supply us with a correct address should you wish to receive such confirmation. |
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Additionally, to comply with the Data Protection Act, we must have your permission to use your e-mail address for marketing purposes. Therefore, if you would like to receive information about our courses via e-mail, please tick this box. |
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Invalid Input |
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Declaration by parent or guardian: I wish for my son/daughter to be accepted for the Wrexham FC Junior Dragons Supporters group. I also give permission for the Junior Dragons to take and use photographs of my child for future Wrexham FC publications and publicity, administer first aid if necessary, and to transfer my child to hospital should an emergency arise.
By Entering my name in the box below,and entering the date,I agree to this statement. |
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| Parent\Guardian Name For Declaration of Consent (*) |
Please type your
full name. |
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| Date of Declaration (*) |
Invalid Input - Enter DOB in this format: 00/00/0000 |
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| Membership fee (annual) |
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| Total |
0.00 GBP |
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| Please enter the characters you see: |
Invalid Input |
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