Hardship Scheme Application Form

Please Note: It is essential that you complete this form at least 3 working days before the trial date you would like to attend. Applications after this time may not be processed. Your application will be responded to by email any time up to 2 working days before a trial event. ALL APPLICATIONS ARE TREATED IN THE STRICTEST CONFIDENCE AND NEITHER PRO11 COACHING STAFF OR THE SCOUTS IN ATTENDANCE AT THE TRIAL WILL BE MADE AWARE OF YOUR APPLICATION.

Please say which trial you wish to apply for (date and location)

Name of the player applying for a place

Name of the person completing this form

Your relationship to the player, eg parent, family member, guardian, carer, social worker, teacher, coach etc.

What is the player's date of birth

What is their current age?

Playing Age Group at time of trial

Player's full address including postcode? Please note all players must be resident in the UK, have a relevant VISA or have been granted refugee status

Contact Telephone Number (Parent if under 16)

Contact Email Address (Parent if under 16)

Email

Confirm Email

1st Preferred Playing Position

2nd Preferred Playing Position

Current Club(s) - please provide name of any clubs the player currently plays for, and any football academy experience they have

Please say why the player wishes to apply for the Hardship Scheme (please tick as many boxes as are relevant)

Does the player have any medical conditions we should be aware of?

Yes
No

Medical Information

Please advise of any current ongoing medical conditions that we should be aware of. Please also feel free to speak to a member of staff about any concerns. If none please write 'None' or N/A

Any further information you would like us to consider in support of this application

If a hardship place is unavailable, would you like us to offer a place at a discounted rate?

Yes please
No thanks

Agreement to Terms & Conditions

I confirm that I have read and understood the Terms and Conditions and understand they apply to me whether I have paid for a place or a place is given for free under the hardship scheme. Terms & Conditions available at www.pro11trials.co.uk/terms-and-conditions

This form has been electronically signed by (please type your name)

Date

PRO11 Hardship Scheme