Child's Date of Birth (Dates may be in US format depending on your settings) *
MM
/
DD
/
YYYY
Address *
Your answer
Eircode *
Your answer
Phone number *
Your answer
Email Address *
Your answer
Any medical conditions including allergies that our Club should be made aware of
If yes please give details including any prescribed medication (name, dosage, frequency).
Your answer
In the event of an emergency do you give Gorey Celtic permission to bring to hospital and to administer medical treatment by suitably qualified person or doctor at the hospital or venue as required. *
Required
Please ensure to pay via the link once you click submit. We are a cashless club, only card payments will accepted. Thank you *