FOOTBALL ACADEMY
REGISTRATION FORM
PARENT INFORMATION
Affix 4
Parent/Guardian Name:__________________________________________
Passport
Photograph
ContactAddress:____________________________________________________
_________________________________________________________________
Telephone:________________________Relationship to Student_____________
_________________________________________________________________
________________________________________________________________
STUDENT INFORMATION
Name:___________________________________________________________
Surname First Middle
Contact Address:___________________________________________________
_________________________________________________________________
Telephone No:__________________Email:_______________________________
Date of Birth:______/_____/_________Age:______ Gender: Male Female
dd mm yyyy
Int’l Passport No. (if any):__________Issuing Date:_______Expiry Date:_______
Present Weight:__________________Present Height:______________________
Present School/Club:_________________________________________________
State of Origin:_______________LGA:_________Nationality:________________
Academic Status: I have completed SSCE I’m still in Sec. Sch. (What Class?______)
Soccer position(s): Striker Mid-fielder, Defender Goalkeeper
Please indicate any medical condition (i.e. Allergies, Asthma, Illness, previous injuries, etc) or
any “special instruction” here_____________________________________________________