Register Mobile | Blackpool Senior Seasiders

Personal details

FIRST NAME

LAST NAME

DATE OF BIRTH

MOBILE PHONE

EMAIL ADDRESS

Home address

STREET ADDRESS

TOWN

POSTCODE

Membership

MEMBERSHIP TYPE
Recreational Member – £10 per yearCompetitive Member – £20 per yearNot Sure – Please Advise Me

WHICH ACTIVITIES ARE YOU INTERESTED IN?
Select all that apply.

Tuesday Recreational SessionFriday Recreational SessionCompetitive or Team FootballOther Club Activities

PREVIOUS WALKING FOOTBALL EXPERIENCE

Emergency contact

EMERGENCY CONTACT NAME

RELATIONSHIP TO YOU

EMERGENCY CONTACT TELEPHONE

EMERGENCY CONTACT EMAIL

Medical information

RELEVANT MEDICAL CONDITIONS, ALLERGIES OR MEDICATION

This information will be treated as confidential and used only to support your safety during club activities.

I explicitly consent to Blackpool Senior Seasiders securely storing and using any medical information I have provided for my safety during club activities and emergencies.

Photography and communications

PHOTOGRAPHY AND VIDEO

Do you give permission for photographs or videos in which you appear to be used on the club website, social media, in the local press and in club publicity?

Yes, I give permissionNo, I do not give permission

OPTIONAL COMMUNICATIONS

I agree to be added to an appropriate club WhatsApp groupI would like to receive occasional club news and promotional emails

Declaration

I understand that walking football involves physical exercise. I will inform a session organiser about any condition or change in my health that may affect my participation and will seek medical advice if I am unsure whether I should take part.

I agree to follow the club’s Constitution, Code of Conduct and recreational walking football rules.

I have read the club’s Privacy Notice and understand how my personal information will be used and stored.

MEMBER SIGNATURE

Please sign in the box above using your mouse or finger. Select Clear if you need to redraw it.

I confirm that this is my digital signature and that the information provided is accurate to the best of my knowledge.