Medial Form
Fields highlighted with an asterisk (*) please complete.
The data provided will help us to deliver a good personal experience.
Participant's Full Name *
Participant's Date of Birth *
MM
/
DD
/
YYYY
Email Address *
Participant's Home Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Doctor's Contact Name/Address *
Doctor's Telephone Number
Please state details of any medical conditions, allergies, asthma etc. *
Please tick the box below if your child is on any medication. If yes, bring all medication in a clear bag marked with your name and age group and hand over to the Club's Welfare/Safeguarding Officer who will assist, if required. *
Required
Please tick the box below if you are happy for us to share your child's photographs on social media. *
Required
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