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Referee CPD Event Registration Form
Thank you for signing up to our Referee CPD Event. We require all attendees to complete this form in full.
Our objective is to meet the safeguarding needs of the children/young people we work with whilst aligning all our key safeguarding and organisational policies, procedures and standards.
Thank you
Ross Joyce
Referee Development Manager
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CPD Event Attendee Details
Forename
*
Your answer
Surname
*
Your answer
DOB
*
MM
/
DD
/
YYYY
Under 18
*
Are you under the age of 18?
Yes
No
Email Address
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Emergency Contact Information
Emergency Contact Name
*
In the event of an emergency, please provide a contact name for us to get in touch with.
Your answer
Emergency Contact Telephone Number
*
Your answer
Additional Support Required
*
Do you require any additional support during the CPD session? (for example because of a disability). If no, please write 'no',
Your answer
Medical Conditions
*
Do we need to know about any medical conditions or allergies? (If yes, please provide details for the condition(s) and any medication needed). If not, please write 'no'.
Your answer
Parent/Guardian Details
To be completed if you are Under 18.
North Riding FA aims to provide a safe and enjoyable experience for every child or young person.
Parent/Guardian Name
Your answer
Parent/Guardian Contact Telephone Number
Your answer
Parent/Guardian Event Permission
My parent/guardian named above gives me permission to attend this Cheshire FA Referee CPD Event
Yes
Parent/Guardian Recording Event Permission
My parent/guardian named above is aware that the event is being recorded. All Cameras will be off during the session.
Yes
Parent/Guardian Attendance
My parent/guardian would like to attend the Referee CPD event in a supervisory capacity.(if Yes, please provide their email address below)
Yes
No
Parent/Guardian Email Address
Please provide your parent/guardian's email address here so that we can send them a link to the event.
Your answer
Conduct
Conduct Agreement
*
I am aware that this event may be attended by people under the age of 18 and understand that I need to conduct myself in an appropriate manner.
Yes
Required
Recording Agreement
*
I confirm in attending this event I am aware that the event will be recorded.
Yes
Required
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