Nairn St Ninian Women’s Walking Football Registration Form

Nairn St Ninian Women’s Walking Football

Fridays 6:30-7:30pm Nairn Sports Club Hall
Participant Information
Name

First Name Last Name
Birth Date

Month Day Year
Address

Street Address

Street Address Line 2

City County

Post Code
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Alt. Phone Number
Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.
Are you prescribed an inhaler? If yes, please explain any instructions.
Do you give permission for photos or videos be taken?

Yes No
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

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