Apply Development Centre Application Player / Family DetailsFirst NameSurnameDate of Birth DD MM YYYY Address Address Line 1 Address Line 2 Town / City County Postcode Parent / Guardian NameContact NumberEmail Current School / Club DetailsCurrent SchoolName of ClubMedical DetailsDoes the child have any of the following medical conditions Asthma Diabetes Epilepsy Please provide details of any allergies the player suffers fromPlease provide details of any medication the player is current takingPlease provide details of any other medical conditions we should be aware ofConsentPlayer images photo contentYesNoAt times the Club may wish to take photos or videos of the team or individuals in it. We adhere to The FA Guidelines to ensure these are safe and respectful and used solely for the purposes for which they are intended, which is promotion and celebration of the Player Development Centres of Worthing FC. We confirm that only image and videos associated with your child’s involvement in football training/matches will be used and never passed on to third parties. Any photos or video footage of your child may be used on the Worthing FC and Worthing Football Centre website and social media pages and/or match day programmes. I give consent for my child to participate in the Worthing FC development centre and agree to the conditions outlined above. I accept that it is my responsibility to inform Worthing FC directly of any changes to the details recorded on this form.* I agree Where did you hear about us?Please state where you first heard of Worthing FC Development Programme*- PLEASE CHOOSE -Word of mouthFriend/referralFacebookTwitterGoogle searchFlyerOtherPlease state Submit This iframe contains the logic required to handle AJAX powered Gravity Forms.