1-2-1 & Small Group Information Form

Child's Full Name*

First NameLast Name

Age*

DOB*

DayMonthYear

Medical Information (please state 'none' if not applicable)*

Name of Junior Football club currently at?*

Age Group?*

At what level does the football team play at?*

Email*

example@example.com

Emergency Contact Number 1*

Emergency Contact Number 2

Name of 1-2-1/Small Group Coach & Venue, e.g Mike @ Victoria Park (if known)

Official Schulz Coaching photographs may be taken of children on any of the courses. These picture will only be used for advertising purposes on official Schulz Coaching publications. If you have any objections to photographs of your child being taken and subsequently used for such advertising purposes, please state in the drop down choices *

I give my child permission to participate in the SCHULZ Coaching programme. I hereby remove SCHULZ Coaching from all and any liability of any kind of personal injury and property damage due to participation in this course. I certify that my child is in good health and able to participate in all activities. If any attention is required for illness or injury I give permission to a staff member for such care in the event that I cannot be contacted. I further authorize any attending paramedic to render any and all medical care he / she may deem necessary.*

Parent / Guardian Full Name*

First NameLast Name

Parent Signature*

Thank you for completing this information form, if you have any questions or queries please feel free to contact us on Tel: 07525 857402 or email us at Marc@schulzcoaching.co.uk

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1-2-1 & Small Group Child Information Form