PL Kicks - Fifa Tournament Registration

This Consent form is for the Burnley FC in the Community's FIFA 21 Tournament.

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* 1. Name of Participant

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* 2. Date of Birth (DD/MM/YYYY)

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* 3. Gender

Male

Female

Prefer not to say

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* 4. What is your street address?

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* 5. Postcode

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* 6. Ethnicity

White British / Irish / Gyspy or Irish Traveller / Other White

Asian / Asian British / Other Asian Background

Black / African / Caribbean / Black British / Other Black Background

Mixed / Mixed Etjhiichity / Other Mixed or Multiple Ethnic Background

Other Ethnic Background

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* 7. Medical Conditions

Yes

No

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* 8. If yes, Please state below

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* 9. Disability

Yes

No

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* 10. If yes, Please state below

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* 11. Console you would like to compete on

Xbox One / Series S/X

PS4/5

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* 12. Gamertag / Username

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* 13. Email Address (For Fixture purposes)

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* 14. Parent / Career's Name

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* 15. Parent / Career's Contact Number

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* 16. Parent / Career's Email Address

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* 17. Does the Parent / Career of the Registered participant give consent of the participant to take part in the online tournament format.

Yes

No