CYC Registration Form

Fill out the form carefully for registration!
Parent/Guardian's Name *
Parent/Guardian's Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Player Name*

First NameLast Name
Date Of Birth*

DayMonthYear
Playing Position

GoalkeeperDefensiveMidfieldAttacking
Please Add Any Details Regarding Objective For 1 To 1 Sessions.
Do You Have Any Medical Conditions?*

YesNo
If 'Yes' please explain briefly?
Activity*

Thursday's 5-11 Y/O From 5Pm-6PMSaturday's 8-11 Y/O From 9:30Am- 10:30AmSaturday's 5-7 Y/O From 10:45Am- 11:45Am1-2-1 Football Sessions
Activity - Week 1*

Monday 21st of July from 10-12 at Redlees ParkTuesday 22nd of July from 10-12 at Redlees ParkWednesday 23rd of July from 10-12 at Redlees ParkThursday 24th of July from 10-12 at Redlees ParkFriday 25th of July from 10-12 at Redlees ParkNone
Activity - Week 2*

Monday 28th of July from 10-12 at Redlees ParkTuesday 29th of July from 10-12 at Redlees ParkWednesday 30th of July from 10-12 at Redlees ParkThursday 31st of July from 10-12 at Redlees ParkFriday 1st of August from 10-12 at Redlees ParkNone
Activity - Week 3*

Monday 25th of August from 10-12 at Redlees ParkTuesday 26th of August from 10-12 at Redlees ParkWednesday 27th of August from 10-12 at Redlees ParkThursday 28th of August from 10-12 at Redlees ParkFriday 29th of August from 10-12 at Redlees ParkNone
If your looking for 1-2-1 session Please tell me you preference time?
Would You Like To Be Add To CYC WhatsApp Group?*

YesNo
Please confirm that you give consent for any photos / video taken in the sessions can be uploaded on to the social media and website of Can You Challenge!*

YesNo
Additional Information:
Should be Empty: