Saturday Football - Hoblingwell Registration Form

Hoblingwell Saturday Football

Hoblingwell Rec, Leesons Way, Orpington, BR5 2QB
Childs Name:*

First NameLast Name
Date of Birth*

MonthDayYear
School Year*
Number only
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN INFORMATION
Parent/Guardian*

First NameLast Name
Mobile Number*
Format: 00000000000.
Home Number

Area CodePhone Number
E-mail address*
example@example.com
Mobile Number*
Format: 00000000000.
MEDICAL INFORMATION
Does your child have any allergies, a chronic illness or have any medical conditions?*

YesNo
If yes - please provide further information and instructions;
Does your child carry an Epi pen?*

YesNo
If yes do you give permission for one of the coaches to administer an EpiPen if needed?*

YesNo
Do you give consent for Dynamic Coaching to use your child's photograph/video on website/social media*

YesNo
In order for Dynamic Coaching to comply with privacy regulations, we will need you to give consent to enable us to add you to our register and contact you via the information provided in this form;*

YES, I consent.NO, I do not consent.
Sessions
prevnext( X )
Football 11am
£7.00 Quantity

Total

£0.00
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Hoblingwell Saturday Football