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Crosfields Cubs Pre Registration Form
Rugby Training for 4-6 year olds
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Player Name
*
Your answer
DOB
*
MM
/
DD
/
YYYY
School Year (current) if applicable
*
Your answer
Address (include Post Code)
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Mobile Number
*
Your answer
Parent/Guardian Email Address
*
Your answer
Medical History
*
Asthma, Bronchitis or any other chest condition
Fainting Attacks, Dizziness or Epilepsy
Diabetes
Heart Condition (including any surgery)
Hayfever
Any Allergies (e.g.Penicillin, Latex, Plasters, Hand Sanitiser)
Any Other Medical Conition
Are you taking any Medication
NO MEDICAL CONDITIONS
Required
Medical History Cont.... If ticked anything other than NO Medical Conditions Please give details below
Your answer
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