Maidstone United RAIDERS Enquiry Form

The Gallagher Stadium,
James Whatman Way, Maidstone,
Kent ME14 1LQ,

info@stonesct.org.uk

Registered Charity No. 1184274
Maidstone United RAIDERS

Enquiry Form
Parent or guardian name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number

Area CodePhone Number
E-mail
example@example.com
Name of person looking to join the club

First NameLast Name
Date of birth

DayMonthYear
Date
Child age at start of programme
Ethnicity
Gender
Are there any medical or special needs we need to be aware of?
If Yes please specify:
Do you give permission for your child to receive first aid if required?
Do you give permission for your child to be photographed and for these to be published online?
Secondary emergency contact name

First NameLast Name
Secondary emergency contact phone number

Area CodePhone Number
Emergency Pick Up Pin (should you not be able to collect them and arrange alternate collection) - four digit number:
By signing this form you are confirming that you are consenting to Maidstone United Raiders, a programme of The Stones Community Trust, holding your details for use in case of a medical emergency.

You can withdraw your consent at any time by contacting the Trust.
Signature
Date

DayMonthYear
Date
Name
Should be Empty: