Rothley Imps Football Holiday Camp Info Form

Rothley Imps JFC - May Half Term Camp - Child Information Form
Child's Full Name*

First NameLast Name
Age*
Date of Birth (DD/MM/YYYY)*

DayMonthYear
D.O.B
Medical Information (please state 'none' if not applicable)*
Affiliated to Rothley Imp JFC*

Plays for a Rothley Imps teamDoesn't play for a Rothley team
Attends Schulz Coaching Academy*

YesNo
Select Days:*

Wednesday 27th MayThursday 28th MayFriday 29th MayFull Week - All 3 DaysEarly Bird Option (£2.50 extra per day)
Parent / Guardian Full Name*

First NameLast Name
Email*
example@example.com
Emergency Contact Number 1*
Emergency Contact Number 2
Official Schulz Coaching photographs may be taken of children on any of the courses. These pictures 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.*
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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Rothley Imps JFC - May Half Term Camp - Child Information Form