ACADEMIC SUPPORT REGISTRATION FORM

SPORTS FOR LIFE ACADEMIC SUPPORT PROGRAM Registration Form

Please complete all sections to enroll in our Academic Support Program
Player Full Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
School Grade*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Program & Schedule
Select the subjects you wish to attend:

EnglishChineseFrenchMathematicsAfter-School Tutorial
Preferred Session Days (Choose one or both):

Tuesday (4:00PM - 6:00PM)THURSDAY (4:00PM - 6:00PM)
Preferred Venue (Select one):

JordanMongkokSham Shui PoTo Kwa Wan
Parent/Guardian Details
Name of Parent/Guadian

First NameLast Name
Relationship:
Email Address
example@example.com
Phone Number

Area CodePhone Number
Emergency Contact
Name:

First NameLast Name
Relationship to Participant:
Phone Number:

Area CodePhone Number
Alternative Number:

Area CodePhone Number
Medical Information & Consent

Please list any allergies, medical conditions or special needs:
Consent:

I give permission for my child to participate in the Sports For Life Academic Support Program.I authorize program staff to seek emergency medical treatment if needed.
Name

First NameLast Name
Signature of Parent/Guardian: ________________________ Date: _______________

Thank you for registering. We will contact you with confirmation and any further details.
THANKS TO OUR PARTNER
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SPORTS FOR LIFE ACADEMIC SUPPORT PROGRAM Registration Form