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PAN Player Development Centre - U12s


Football sessions for everyone from under 12 years that offers all people with disabilities the chance to play football, engage with other participants with a similar interest and passion to play football.

Please ensure you wear appropriate footwear (moulded boots) and shinpads for each session.

** Please be aware sessions may be postponed due to Burton Albion FC fixtures ** 

 

Online Registration Form
Price category

Session









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Attendee's First name
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Attendee's Last name
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Date of birth
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Medical / Disability Information
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Parent / Guardian Name
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Email
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Mobile
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Address 1
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Address 2
City
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Postcode
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Medical & Participation Information
Are there any special dietary needs (e.g. vegetarian, vegan, gluten free)?
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Does the attendee have any allergies (e.g. nuts, penicillin, hayfever)?
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Does the attendee have any medical information that we need to be aware of (e.g. asthma, diabetic, epilepsy)?
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Will the attendee carry any required medication during the course?
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Please give details of any other medical and participation information that we need to be aware of.
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Please include details of medication that your participant may be bringing along, and if the attendee requires any access needs:
Media Consent
I have read and agree to the below statement.
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I consent that during the course photography/videos of the attendee may be taken during the session. These may then be used for the purpose of advertisement and promotion on through website, social media, and print media.
On behalf of
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Please select "yes" or "no" to the below options.
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If an emergency situation arises, for administration of first and and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary and in the comfort that in such circumstances that all reasonable steps are made, can Burton Albion act on your behalf?
 *
 *
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