Maynooth Town FC Academy Registration Form

Block 1 Season 2016/2017 Starting August 26th

69 for the 10 Weeks
Please contact Ciaran on 089-439 6114 if you have any questions
Check your Emails & Social Media on Facebook for all our updates
Outline New Selection Age Group

We will have 3 Groups on Fridays under new times going forward

Junior Strikers Ages 4 to 6 Operating Time 5.30 to 6.30
previously 6pm group
Senior Strikers Ages 7 to 8 Operating Time 6.00 to 7.00
previously 7pm group
Galcticos Ages 9 to 16 - 6.00 to 7.15 Friday
previously 8pm group

Email Address: ___________________________________________________ _______block capitals please

Registration form required for all players

Name:
DOB:
Address:
Boy

Guardian Personal Data

Name:
Address: if different
Contact Number:

________________________________________________________
________________________________________________________
________________________________________________________
Girl
( please tick Box )

_________________________________________________
_________________________________________________
_________________________________________________

Football Data

Team Manager Name: __________________________________________

Position Preference: _______________
Registered with Maynooth Town FC in 2016/2017 Yes
or No

Academy Training Jacket 20, Complete Free Shorts & Socks Section also

Training Jackets

XX Small

XS

Small

Medium

Large

Free Shorts & Socks XX Small

XS

Small

Medium

Large

Medical History
Please State all relevant medical History that may affect your child while playing sport and any special
notifications that need to be made to the Academy:
__________________________________________________________________________________________
__________________________________________________________________________________________
All Guardians will be added to the Academy Mail Merge in the Interest Of Sharing Academy Information
with you with regards to the running of the Academy. Please tick if you would prefer not to be contacted
with regards any relevant information about the Academy by Text
Only Tick If you do not want to be contacted

Club & Academy Director of Coaching:

Academy Director & Club Board Member:

Ciaran Quinn
Paul Brogan