The following form gives us your player details and lays out the rules for the academy. Please fill this out and this will be sent to us and stored for safekeeping.

Name

First Name

Last Name

Email Address

DOB

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile

(###)

###

####

Home

(###)

###

####

Family Details

Brothers, sisters and parents names.

Living Arrangements

One Dwelling

Two or more Dwellings

Playing Details

Current Football Team

Current Football Grade

Team Playing Schedule

Please enter the link to your teams draw on the football south website (or otherwise). Our coach needs to know when and where you are playing so that he can observe you playing within the team.

Example: http://www.foxsportspulse.com/team_info.cgi?id=20548139&c=1-6262-0-305195-0

http://

Additional Football Team

Additional Team Playing Schedule

http://

Playing Position(s)

List your preferred playing positions in order of preference

Long term Football Goal

Please tell us about your long term dream with football. We need to know what your goal is so that we can help you get there.

Short term Football Goal

What is a goal that you could reach within the next six months?

Player Identified Strengths

Please list what you consider your strongest qualities, i.e. what you do well at the moment on the field.

Player Identified Needs

Please list anything you feel you need to work on.

Favorite Club

Favorite Player

Academy Rules

The Player Agrees to

• attend the Academy regularly and punctually, behave with self-discipline and give notice of and reason for any absence.
• practice the techniques and skills taught by the academy and attempt to apply them in matches.
• attend school regularly and punctually, complete school assignments and behave at school as at the academy
• follow a lifestyle appropriate to development - spending leisure time positively; eating, drinking, relaxing and sleeping sensibly.

The Parents / Guardians Agree to

• encourage and help the Young Player meet targets, including this Code of Conduct and the Club’s Code of Conduct.
• support for the Young Player without pressure, praise good work and refrain from criticising lapses.
• set a good example for the Young Player.
• communicate with the academy staff, keeping them informed about matters affecting the Young Player.
• refrain from making comments to their own children or other children in the programme during a session or game. It is unhelpful and creates distraction and confusion, if you have concerns please wait until after a session or game to discuss with the coach.

Agreement

I and my child agree to the academy rules above.

I Agree

I Disagree