2021 Junior Registration Form

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Player's details

First name *

Surname *

Date of birth *

(day/month/year)

YYYY

School

Parent / Legal Guardian's details

Name *

Relationship to child *

Parent

Other:

Address *

Contact telephone number *

Email address *

Emergency Contact Details (Alternative contact)

In the event of an incident or emergency situation where a parent, or legal guardian named above cannot be contacted, please provide details of an alternative adult who can be contacted by the club. Please make this person aware that his or her details have been provided as a contact.

Name *

Relationship to child *

Contact telephone number *

Information about any impairment

Please provide information about any impairment your child may have so that we can determine what reasonable adjustments may be required to support your child’s full participation in the programme.

Do you consider your child / the child in your care to have an impairment? *

Yes

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