Request for a Free Date Form

Eastham & District Junior Football League
FORM E&DJFL 1
REQUEST for a FIXTURE BREAK due to SCHOOL Trip or CLUB Tour (Rule 10.a & Bye- Law 14 f )

From (Club) :- ________________________________ F.C. Today’s Date_________________

We hereby apply for a BREAK in FIXTURES in accordance with Rule 10.A. and supply the following information for the
consideration of the League Committee.

TEAM (Age group) :_____________________ Division : ________________

Total NUMBER of PLAYERS Registered with this team :- _____________________

DATE for which the FIXTURE BREAK is requested : - i.e. SUNDAY______________________

REASON why the BREAK is being requested:- ______________________________________________________


LIST of PLAYERS affected by the Trip or Tour

PLAYER’S NAME SCHOOL ATTENDED (if School Trip)
1
2
3
4
5
6
7
8
9
10

Contacts at the School or Schools:-
Name of Teacher (s) or Organiser(s) _____________________________ ____________________________

Contact Phone No.(s) _________________________ ____________________________

Name of person requesting the Fixture Break :- _______________________________

Signature:________________________________ Position in Club :- ______________________


Please forward completed form to the APPROPRIATE FIXTURE SECRETARY,
Alf Roberts, 8 Cecil Road, New Ferry, Bebington, Wirral. CH62 1AY

NB – PLEASE NOTE THE REQUIREMENT TO SUBMIT THIS REQUEST AT LEAST 21 DAYS PRIOR TO THE
TRIP OR TOUR AND THAT THE E&DJFL RESERVES THE RIGHT TO VERIFY THE INFORMATION SUPPLIED.