Parental Consent & Registration Form

A Different Way, Instilling a love of sport ensuring life long participation. 

Following your child's free tasters we hope that you entrust us with the development of your child, it is a responsibility we do not take lightly. On your child completing their two free taster sessions you will receive an estimate of your monthly fees together with full membership details.

Childs Details
First Name
Last Name
Date of birth *
Date of birth
Playing Experience
Parent/Carer Details
Parent/Carer Name *
Parent/Carer Name
Medical & Emergency Details
Please provide contact details different to those provided above incase we are unable to reach you.
Emergency Contact Name *
Emergency Contact Name
Membership Fees *
Please tick the payment schedule you would like for your child's membership. (Please note all payments are done by standing order and there is a minimum 12 week commitment)
Kit Options *
Please select the kit option you would like.
Data Protection: Here at Hereford Futsal we take your privacy seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us. Please click below for our full Privacy Policy. However, from time to time we would like to contact you with details of other events and offers and with information such as newsletters and company updates. We will never pass your details on to any 3rd parties for marketing purposes. We may also, from time to time take photographs for marketing purposes, by ticking the box below you are providing your consent for us to do so. Safeguarding: It is your responsibility to ensure your child is dropped off and collected safely by a parent or guardian from the coach at any of our events (Sessions/Holiday Weeks etc), we will do our upmost to ensure this.
Signed *
I can confirm that I agree with the above terms and conditions and by clicking Submit I am electronically signing the consent form