WEST BROMWICH ALBION FC ACADEMY PLAYER PLACEMENT PLAN
Young Player Full Forename & Surname:
Date Of Birth:
Young Player Parent /
Legal Guardian 1:
Start Date:
Full Forename:
Full Surname:
Home Address:
Home Number:
Mobile Number:
Alt Number:
Email Address:
Young Player Parent /
Legal Guardian 2:
Full Forename:
Full Surname:
Home Address:
Home Number:
Mobile Number:
Alt Number:
Email Address:
Young Player Religion:
Place of worship:
Attendance:
Times:
Mon
Tues
Weds
Thurs
Fri
WEST BROMWICH ALBION FC ACADEMY PLAYER PLACEMENT PLAN
GP Contact Details:
Name of GP:
Address:
Telephone Numbers:
Medication:
Prescription 1:
Name of prescription drug /
medicine:
Purpose:
e.g. Cream, tablet etc.
Dose/strength:
Time taken & how often:
How taken:
Storage Information:
Repeat prescription needed:
If yes, how often:
Prescription 2:
Name of prescription drug /
medicine:
Purpose:
e.g. Cream, tablet etc.
Dose/strength:
Time taken & how often:
How taken:
Storage Information:
Repeat prescription needed:
If yes, how often:
Non Prescription
Players may take:
Asprin
Ibuprofen
Other:
Allergies:
1.
3.
2.
4.
Paracetamol
WEST BROMWICH ALBION FC ACADEMY PLAYER PLACEMENT PLAN
Consent: In the event of emergency, consent
of medical treatment can may be given:
Any restrictions on emergency Yes
medical treatment? E.g.
blood transfusions, organ
transplant etc.
Restrictions:
Consent for routine medical
or dental treatment:
Contact of Young Player:
Yes
Are there any court order
which regulate or prohibit
contact between the young
player and any other person
Details
Diet and restrictions:
Special dietary requirements?
Yes
No
No
Details
Details
No
Food allergies / intolerance
Yes
No
No
Supplements
Yes
Yes
Details
No
Restricted Activities:
Drink Caffeine
Watch films or play computer
games with a certificate
indicating they are not
suitable for young players
Will the parent/guardian give
pocket money to the young
player?
If so how much per week
Will the player look after their
own finances?
Yes
No
Yes
No
Yes
No
Yes
No
WEST BROMWICH ALBION FC ACADEMY PLAYER PLACEMENT PLAN
If no, who is responsible for
looking after the players
finances?
Parent / Guardian 1 with legal parental responsibility:
Name: _______________________________
Signature: __________________________________
Date: ________________________________
Parent / Guardian 2 with legal parental responsibility:
Name: _______________________________
Date: ________________________________
Signature: __________________________________