CYC Summer Camp Registration Form

CYC Football Community Registration
Player Information
Player's Name*

First NameLast Name
Birth Date*

MonthDayYear
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IndianPakistaniBangladeshiChineseNoneOther
CaribbeanAfricanNoneOther
White and Black CaribbeanWhite and Black AfricanWhite and AsianNoneOther
English, Welsh, Scottish, Northern Irish or BritishIrishGypsy or Irish TravellerRomaNoneOther
ArabNoneOther
Every Friday At (Feltham Park, TW14 9DN) From 5PM- 7PMEvery Saturday At (Inwood Park, TW3 1XA) From 12:30PM- 2:30PM
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: 0000-000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: 0000-000-0000.
Does the player have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the player prescribed an inhaler? If yes, please explain any instructions.*
YesNo
YesNo
Date*

DayMonthYear
Date
Signature*
Should be Empty:

CYC Football Community Registration