Junior Registration 19th June 201622nd August 2016 Please use the form below to register your details for the 2016/2017 season. * indicates required field Child's Name:* Date of Birth:* Ethnic Group:* White - British White - Irish White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Other Black or Black British - Caribbean Black or Black British -African Black - Other Chinese Other Ethnic Group If other Please Specify: School* Home Address* Does the child suffer from Asthma* No Yes Any other relevant medical conditions (e.g. allergies) Age Group* Boys U6 - Stu Woodland Boys U7 - Matt Chaplin Boys U8A - Sean Amos Boys U8B - Ian Starr Boys U9A - Don Russell Boys U9B - Karl Cook Boys U10A - Carlene Semple Boys U10B - Sean Evans Boys U11A - Brendan Withey Boys U11B - Rob Bird Boys U11C - Paul Milsom Boys U12A - Russell Hemmings Boys U12B - Sean Ryan Boys U13A - Mark Partridge Boys U13B - Neil Carey Boys U13C - Craig Hopkins Boys U14A - Mark Houselander Boys U15A - Craig Withey Boys U15B - Harman Boyce Boys U16C - Roger Hayes Boys U18A - Martin Williamson Boys U18B - Matt Bailey Girls U8-U10 - Matt Britt Girls U11 - Steve Brain Girls U12 - Ade Sweet Girls U13 White - Suzanne Allen Girls U13 Blue - Abi Nicholas Girls U14 - Dean Taylor Girls U15 - Kevin Allen We would like to responsibly use photographs of your child on our website and for other promotional material. We will never publish your child’s name next to a photograph bearing their image. Our full child protection policy can be viewed at www.aek-bocofc.com. If you do not consent to this, please tick this box PRIMARY Contact Name:* PRIMARY Contact Address:* PRIMARY Contact Relationship to child:* PRIMARY Contact Telephone No:* PRIMARY Contact Email Address:* SECONDARY Contact Name: SECONDARY Contact Address: SECONDARY Contact Relationship to child: SECONDARY Contact Telephone No: SECONDARY Contact Email Address: Fees for 2016 / 2017 have been set as follows, Please select amount paid:* 1st Child: £10 Additional Child: £5 Player Declaration: By ticking this box I agree to abide by the rules of AEK-BOCO F.C. In doing so, I agree to abide with the Code of Conduct available online at www.aekboco.co.uk. Furthermore, I understand that a failure to comply with the Code may result in my being unable to continue playing for AEK-BOCO F.C.* Parental Declaration: By ticking this box I agree to abide by the rules of AEK-BOCO F.C. In doing so, I agree to abide with the Code of Conduct available online at www.aekboco.co.uk. Furthermore, I understand that a failure to comply with the Code may result in my child being unable to continue playing for AEK-BOCO F.C. In addition I acknowledge that any football kit / equipment supplied to me or my child is the property of AEK-BOCO F.C. and must be returned when requested, otherwise a charge will be levied to cover the cost of the replacement:* Boost your donation by 25p of Gift Aid for every £1 you donate Tick here to Gift Aid your donation and any donations you make in the future or have made in the last 4 years to AEK-BOCO F.C. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.