Millwall PL Kicks Registration Form

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Millwall PL Kicks Registration Form - Dockland S

Millwall Premier League Kicks Registration form Girls Only session (8-11) for the Docklands Settlement, 400 Salter Road, Rotherhithe, SE16 5AA (5-7pm)

• Any player who is found to be under the influence of drugs or alcohol will be subjected to being removed from the session.
• Respect the facilities including building and equipment.
• Any player who feels threatened, intimidated, bullied or discriminated against should report this to MCT staff.
• I will arrive at the session ready to take part, with the correct clothing and footwear.
• No racist, sexist, use of abusive language or behaviour will be tolerated.
• No alcohol or drug consumption is allowed whilst in the facility.
• I will respect Millwall Community Trust staff members and participants at all times.
• I will not deliberately put myself or anyone else at risk throughout the session.
• I agree to not act unlawfully, intentionally threaten, or use a weapon towards another person.
• I agree to not act in such a way that there is an immediate risk of serious physical harm to myself or other people
• I will inform Millwall Community Trust staff if anyone is in breach of the Code of Conduct or is putting either themselves or others at risk.

Email *

Surname *

Age *

Date of birth *

YYYY

Address *

Post code *

Ethnicty *

Asian/Asian British - Indian

Asian/Asian British - Pakistani

Asian/Asian British - Chinese

Asian/Asian British - Bangledeshi

Asian/Asian British - Other

Black British - African

Black British - Caribbean

Black British - Other

Black African

Black Carribean

Mixed/Multiple ethnic groups - White and Asian

Mixed/Multiple ethnic groups - White and Black African

Mixed/Multiple ethnic groups - White and Black Caribbean

Mixed/Multiple ethnic groups - Other

Mixed/Multiple ethnic groups - Unspecified

White - Welsh/English/Scottish/Northern Irish/British

White - Irish

White - Gypsy, Roman or Irish Traveller

White - Eastern European

White - Unspecified

Other Ethnic Group - Arab

Other Ethnic Group - Other

Other:

Photo/Filming Consent for promotional purposes *

Yes

Disability *

Medication *

Emergency Contact Name 1 *

Emergency Contact Number 1 *

Emergency Contact Email Address 1 *

Emergency Contact Name 2

Emergency Contact Number 2

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