2015/16 National League Player Registration

Player information

Please complete this online form to Register for participation in the WFA 2015/16 National League.

This form is in 3 sections:
1. Player information
2. Further information
3. Declaration - Please print this page and give a copy to your Club.

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* 1. Club Name:

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* 2. Squad Number: (This is the shirt number that you will wear all season)

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* 3. Player details

First name:

Surname:

Email address:

Telephone number:

Home Postcode:

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* 4. Date of Birth:

Date of Birth

Date

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* 5. Gender:

Male

Female

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* 6. Nature of Impairment / Condition

Muscular Dystrophy (all types)

Cerebral Palsy

Spinal Muscular Atrophy

Spina Bifida

Brittle Bones

Prefer to not answer

Other (please specify)

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* 7. Emergency Contact details

Emergency Contact Name:

Emergency Contact Telephone:

Relationship to Player (Parent, Carer etc)