CYC Summer Camp Registration Form

CYC Football Community Registration
Player Information
Player's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Asian or Asian British*

IndianPakistaniBangladeshiChineseNoneOther
Black, Black British, Caribbean or African*

CaribbeanAfricanNoneOther
Mixed or multiple ethnic groups*

White and Black CaribbeanWhite and Black AfricanWhite and AsianNoneOther
White*

English, Welsh, Scottish, Northern Irish or BritishIrishGypsy or Irish TravellerRomaNoneOther
Other ethnic group*

ArabNoneOther
Activity*

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.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
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.*
Would You Like To Be Add To CYC WhatsApp Group?*

YesNo
Please confirm that you give consent for any photos / video taken in the sessions can be uploaded on to the social media and website of Can You Challenge F.C!*

YesNo
Date*

DayMonthYear
Date
Signature*

Clear
Should be Empty:

CYC Football Community Registration