Email Address (please use same email as payment form) *
Your answer
Do you have 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 case of emergency please give Name and Phone Number of someone club could contact
Your answer
In the event of an emergency 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
Did you register to play for Gorey Celtic for 21/22 season? If not additional forms maybe required, you will be contacted by your manager if so. *