Course Registration Form

Athlete Registration Form

Fill out the form carefully for registration
Athlete Information
Team Selection*
Athlete Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Athlete E-mail
example@example.com
Athlete Mobile Number
Medical Information
You will be participating in a vigorous athletic activity which will include dance, jumps, stunts, mounts, dismounts and gymnastic tumbling.

If you have any medical conditions or injuries that may inhibit or restrict your participation please list them below.
Please list any known medical conditions
Are you currently taking any medication
Please list any known allergies ( including non-medical )
General Practitioner Information
GP Name*

First NameLast Name
GP Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian (if athlete under 18 years)
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Mobile Number
Parent/Guardian E-mail
example@example.com
Emergency Contact Information
Emergency Contact (1)*

First NameLast Name
Emergency Contact (1)*
Please enter a valid phone number.
Emergency Contact (2)

First NameLast Name
Emergency Contact (2)
Please enter a valid phone number.
Additional Information
We communicate with our athletes and our parents via email and also our own club app.

Please download TeamApp onto your iPhone, Android or Tablet and search for Vengeance Allstars. Create your own username and password and then request access.
Photography Consent

I hereby grant permission to Vengeance Allstars, it's subsidiaries and representatives to photograph and video me/my child and otherwise capture my/my child's image, and to make recordings of my/my child's voice.

I further grant to Vengeance Allstars, it's subsidiaries and representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicising or explaining Vengeance Allstars and its activities and for administrative or educational purposes. Photographs, video
images and voice recordings are the property of Vengeance Allstars.

By signing below, you agree and accept to the above photography concent.
Parent/Guardian/Athlete Signature (over 18 only)*

Clear
Set up Direct Debit with Vengeance Allstars

1st payment will be taken on 1st May after your free trial period has expired
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sort Code*
Account Number*
Name on Account*
Email*
example@example.com
Should be Empty:

Athlete Registration Form

Athlete Information

Medical Information

General Practitioner Information

Parent/Guardian (if athlete under 18 years)

Emergency Contact Information

Additional Information