Chichester City FC Summer Soccer Camp

Chichester City FC Summer Soccer Camp

12th - 16th August 2024
Child Information
Child's Name*

First NameLast Name
Birth Date

DayMonthYear
Age*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Parent/Guardian Information
Name*

First NameLast Name
Mobile Number*

Area Code (just put 00)Phone Number
Home Number*

Area CodePhone Number
E-mail*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Mobile Number*

Area Code (just put 00)Phone Number
Alt. Phone Number

Area CodePhone Number
Does your have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Does you child use an inhaler? If yes, please explain any instructions.*
Please tick which day/s your child would like to attend. Cost is £25 per day (10% off for whole week)

MondayTuesdayWednesdayThursdayFriday
Parent or guardian declaration :

I confirm that the above details to the best of my knowledge are correct at this point in time.

I agree that my child will abide by the rules of the centre and follow the instructions of the staff at all times.
Signature*

Powered by Jotform SignClear
Payment Details
Account Name: Chichester City & Portfield United Ltd
Sort Code: 40-17-16
Account Number: 21852426
Reference: Please use child’s name
Should be Empty:

Parent or guardian declaration :