Isle of Wight Council

	MEDINA 5-A-SIDE FOOTBALL LEAGUE ENTRY FORM
	This form needs to be completed and taken to the Medina Leisure Centre. Completion of the form does not confirm entry into the league. You must contact Medina (see contact details) to enter.

	Team Name
	Team Colours	Shirts Shorts

	Team Members
	A minimum of 10 names must be completed with signatures prior to entry. Include all Saturday/Sunday league teams that members are signed for.
	1.

	Full Name (Chairman)
	Address
	Phone
	Date of Birth
	Other Teams

Signature

2.

	Full Name (Secretary)
	Address
	Phone
	Date of Birth
	Other Teams

Signature

3.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

5.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

6.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

7.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

8.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

9.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

10.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

11.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

12.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

13.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

14.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

15.

	Full Name
	Address
	Phone
	Date of Birth
	Other Teams

Signature

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013