Sauchie Amateurs Community Club OFFICIAL REGISTRATION FORM Name: ____________________________________________________________________________ Address: __________________________________________________________________________ _____________________________ Postcode: ____________________________________ Resident From: _________________________ Tel. No. Home: _________________________ Work: _____________________________________ Mobile: ___________________________ D.o.B: __________________________________ Town Of Birth (PVG Required): __________________________ Email: ____________________________________________________________________________ Have you had a PVG Scheme check? YES NO When: ________________________ For: ________________________________________________ Number: __________________________________________________________________________ Please provide your address history in the last 5 years if above answer is NO (Most recent first, EXCLUDING current address & only if coaching Child or Youth Teams) Name (if previously known by another name): __________________________________________ Address: __________________________________________________________________________ _____________________________ Postcode: ____________________________________ Resident From: _____________ to ________________ Please use another sheet of paper if required for your address history in the last 5 years Sauchie Amateurs Community Club Emergency Contact: Name: ____________________________________________________________________________ Address: __________________________________________________________________________ _____________________________ Postcode: ____________________________________ Tel. No. Home: _________________________ Work: _____________________________________ Mobile: ___________________________ Email: ____________________________________________________________________________ Are you currently (Circle as appropriate) EMPLOYED UNEMPLOYED STUDENT SELF-EMPLOYED RETIRED Other: ____________________________________________________________________________ What days and times are you available to volunteer? (Tick as appropriate) Day Morning 9.00– 10.00 10.00 -11.00 11.00– 12.00 Afternoon 12.001.00 1.002.00 2.003.00 3.004.00 Evening 4.005.00 5.006.00 6.007.00 7.008.00 8.009.00 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Have you volunteered for a football/sports Club before? Please Circle YES NO If yes, give details: __________________________________________________________________ __________________________________________________________________ State any relevant qualifications or experience: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Sauchie Amateurs Community Club Do you have any criminal convictions? YES NO If yes, please give details: _____________________________________________________________ __________________________________________________________________________________ Medical Information Do you consider yourself to have a disability or medical condition? YES NO If yes, give any information that may be relevant to volunteering in this type of work: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Are you on any medication? YES NO If yes, please give details: _____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Do you have any current or reoccurring injuries? YES NO If yes, please give details: _____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ References Name: ______________________________ Name: ___________________________________ Address: ____________________________ Address: _________________________________ ____________________________ _________________________________ Postcode: ___________________________ Postcode: ________________________________ Sauchie Amateurs Community Club DECLERATION I declare that the information given on this Official Registration Form is true to my knowledge and understand that any false information will result in my disqualification from Sauchie Amateurs CC with immediate effect. I agree for my details to be held on the Club database and can be used on the Club’s website or Social Media pages. I declare that I have read and signed (where appropriate) the following Club documents and agree to abide by them: Club Mission Statement Anti Bullying Policy Anti Discrimination Policy Team Selection Policy Coach/Officials Code of Conduct Job Description Officials Name: ______________________________________________________________ Officials Signature: __________________________________________________________ Position: _____________________________________________________________________ Age Group/Team: ___________________________________________________________ Chairperson/Secretery Name: _____________________________________________ Chairperson/Secretery Signature: _________________________________________ Date: ___________________________________________________________________________
