Sign Up Form
If you have any queries regarding this form, please email lauracalla@gmail.com
Name *
Your answer
Trial Age Group *
This is the age group you wish to trial for. For example if you are Under 15 but trialling for the U18, please tick U18. Please also note that U13 players are unable to trial for U18 due to ELA rules.
Name of Parent/Guardian *
Your answer
Preferred Email *
Your answer
Preferred Contact Telephone Number *
Your answer
Emergency Contact Details (if different from above)
Your answer
GP Details (name and telephone number) *
Your answer
Does the player have any medical conditions, allergies or any relevant medical history? *
If YES, please give details
Your answer
Does the player take any medications regularly? *
If YES, please give details
Your answer
Age as at 1st September 2019 *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School Year *
Your answer
School *
Your answer
Player Eligibility: To be eligible to play for Cheshire, you need to play for any of the following clubs *
Required
Preferred Playing Position (tick all appropriate) *
Required
Previous Playing Experience (tick all appropriate)
ELA Registration Number (7-DIGIT NUMBER)
Your answer
I have paid £15 via BACS - citing daughters name as the reference *
Please email lauracalla@gmail.com when paid (this will not always be a requirement but whilst getting the payment system up and running this will be helpful).
Payment details:
Name: Cheshire County Lacrosse
Sort Code: 40-17-06
Account Number: 41297562
Data Protection and Safeguarding *
Required
Consent to the use of photos and give permission for coaches/management to administer emergency medical treatment *
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