Membership Form
POLOKWANE CITY YOUTH DEVELOPMENT TEAM
DRAFT MEMBERSHIP APPLICATION FORM
(To be completed before signing the main form)
(To be completed before signing the main form)
Date : ________________
Surname: ______________________________ Names: _____________________________________________________________
Date Of Birth: ___________________ Place Of Birth: ___________________ Country Of Birth: ______________________________
Playing Position: _________________ Optional Playing Position: _______________ Jersey No: _______
Current Age: _____ Birth Certificate/ Identity Number: _________________ Cellphone No: __________________________________
Parents Information
Mother: __________________________ Identity No: ______________________ Cell No: _________________________________
Work: __________________________________ Work Contact: ______________________________________________________
Email Address: ______________________________________________________ Fax: ___________________________________
Father: ___________________________ Identity No: ____________________ Cell No: ___________________________________
Work: ______________________________ Work Contact: ___________________Fax: ___________________________________
Email Address: _____________________________________________________________________________________________
For Incase Of Emergency
Next Of Kin: ___________________________ Contacts: ______________________ Fax: __________________________________
Relationship to the Player: ________________
Family Doctor : _________________________ Contacts: ____________________ Fax: ___________________________________
Allergies: ________________________________________________________________________________________________
Is the player suffering of any sickness or taking any medication: _______________________________________________________
Any Previous sicknesses or injuries: ____________________________________________________________________________
Training kit Size: ________ Tracksuit ________ Shoe ________ T-Shirt _______
I ___________________________ the Player herewith apply for membership of the above mentioned academy. I understand that this is a soccer institute and i am required to pay a registration fee once off and a monthly fee. I fully understand that i must be fully disciplined and respect the academy authority and my team mates. I fully understand that i am personally responsible for my possessions while in the academy and that i fully indemnify the academy from any responsibilty pataining to my loss and while on academy activities my injuries or loss of life. I fully understand that the academy will take care of me incases of emergency working together with my parents and family. I understand fully that the academy does not tolerate Drug, alcohol and smoking including any ill habit and behaviour. Shall i brake any provision of the academy laws and regulations, i authorise the management to punish or suspend me from the academy or if seemed fit to dismiss me. I will honour and respect the academy uniforms and will never ever participate in any activities except for my academy and not even play street football or play for any team while under the academy.
Date: ___________________ Signature : ______________________ ID/Birth Cert ________________
UNDERTAKING BY PARENTS
I _________________________ the parent of ______________________ herewith give consent to my child to be full part and a member of POLOKWANE CITY YOUTH DEVELOPMENT TEAM. I have read the clause above and fully support the academy in the development of my son and i agree to what is written above. I understand tha i must pay a once annual registration fee of R1800and a monthly fee of R2200 which i will pay before or on the 3rd of every month. I fully understand that failing to pay on the stated date will render a daily penalty of R50.00 per day to my monthly fee and i promise to pay the fee shall i surpass the payment dates. It is my duty as a parent to work hand in hand with the academy in the development of my son and in all cases of emergencies and very serious issues concerning my child. I understand that football is a contact sport therefore i take responsibility to support and work with the academy shall anything arise that will need my immediate attention. I will not blame Polokwane City Rovers Fc and its development side, Stake Holders, Landlords, Coaches or the management for any accidents, loss or damages including injuries to my child but will work hand in hand with my child's academy.
Date: ______________ Signature: _________________ ID: ________________________________
Witness: ____________________________ ID: __________________________ Sign: __________
REQUIREMENTS
Surname: ______________________________ Names: _____________________________________________________________
Date Of Birth: ___________________ Place Of Birth: ___________________ Country Of Birth: ______________________________
Playing Position: _________________ Optional Playing Position: _______________ Jersey No: _______
Current Age: _____ Birth Certificate/ Identity Number: _________________ Cellphone No: __________________________________
Parents Information
Mother: __________________________ Identity No: ______________________ Cell No: _________________________________
Work: __________________________________ Work Contact: ______________________________________________________
Email Address: ______________________________________________________ Fax: ___________________________________
Father: ___________________________ Identity No: ____________________ Cell No: ___________________________________
Work: ______________________________ Work Contact: ___________________Fax: ___________________________________
Email Address: _____________________________________________________________________________________________
For Incase Of Emergency
Next Of Kin: ___________________________ Contacts: ______________________ Fax: __________________________________
Relationship to the Player: ________________
Family Doctor : _________________________ Contacts: ____________________ Fax: ___________________________________
Allergies: ________________________________________________________________________________________________
Is the player suffering of any sickness or taking any medication: _______________________________________________________
Any Previous sicknesses or injuries: ____________________________________________________________________________
Training kit Size: ________ Tracksuit ________ Shoe ________ T-Shirt _______
I ___________________________ the Player herewith apply for membership of the above mentioned academy. I understand that this is a soccer institute and i am required to pay a registration fee once off and a monthly fee. I fully understand that i must be fully disciplined and respect the academy authority and my team mates. I fully understand that i am personally responsible for my possessions while in the academy and that i fully indemnify the academy from any responsibilty pataining to my loss and while on academy activities my injuries or loss of life. I fully understand that the academy will take care of me incases of emergency working together with my parents and family. I understand fully that the academy does not tolerate Drug, alcohol and smoking including any ill habit and behaviour. Shall i brake any provision of the academy laws and regulations, i authorise the management to punish or suspend me from the academy or if seemed fit to dismiss me. I will honour and respect the academy uniforms and will never ever participate in any activities except for my academy and not even play street football or play for any team while under the academy.
Date: ___________________ Signature : ______________________ ID/Birth Cert ________________
UNDERTAKING BY PARENTS
I _________________________ the parent of ______________________ herewith give consent to my child to be full part and a member of POLOKWANE CITY YOUTH DEVELOPMENT TEAM. I have read the clause above and fully support the academy in the development of my son and i agree to what is written above. I understand tha i must pay a once annual registration fee of R1800and a monthly fee of R2200 which i will pay before or on the 3rd of every month. I fully understand that failing to pay on the stated date will render a daily penalty of R50.00 per day to my monthly fee and i promise to pay the fee shall i surpass the payment dates. It is my duty as a parent to work hand in hand with the academy in the development of my son and in all cases of emergencies and very serious issues concerning my child. I understand that football is a contact sport therefore i take responsibility to support and work with the academy shall anything arise that will need my immediate attention. I will not blame Polokwane City Rovers Fc and its development side, Stake Holders, Landlords, Coaches or the management for any accidents, loss or damages including injuries to my child but will work hand in hand with my child's academy.
Date: ______________ Signature: _________________ ID: ________________________________
Witness: ____________________________ ID: __________________________ Sign: __________
REQUIREMENTS
- 4 ID Photos
- Certified copies of ID/Birth Certificate for both parents and the player
- Copy of School Report or Matric certificate
- Medical Certificate
- R2200 plus R1800 first payment covering Admin Fee, Registration, Monthly Fee, Tracksuit and T-Shirt
- The following month payment is R2200-00 Covering Transport to and from matches, transport to and from school