Year 8-9 Registration

Address *

Telephone *
Emergency Contact Number *
Email *
example@example.com
Medical Details
Any specific conditions or allergies requiring medical treatment, medication or special attention *

Yes No
If yes; please provide details for each player
Disability Information
Does your child have a disability? *

Yes No
If yes; please provide details
Consent

I agree to have my child photographed/videoed for publicity purposes in line with the NW/CI child protection policy. I give permission for the coaches present to give the immediate necessary first aid & and take appropriate steps to ensure minimum delay if a medical emergency arises.
Form Completed by *
Date *

Day Month Year Date Picker Icon
Please note to be fully insured and accepted onto this program payment must be made by 27/01/20
Payment *

Full Program Online (£80) Full/Deposit brought to next session
Payment Online

Full Program £ 80.00 GBP

Total £ 0.00 GBP

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Online Registration