What package have you signed up for? *

Name of Student *

Date of Birth of Student *

Address (including postcode) *

Club Team *

What level of hockey have you played? *

Parent/Guardian name (if under 18)

Contact email address (should be parent/guardian if student is under 18) *

Contact Number (should be parent/guardian if student is under 18) *

Parental Consent and confirmation you will be present in the room for all 1:1 calls and webinars (under 18s only) *

Medical History *

If other, please provide more details

Do you have any other illnesses/ injuries that may prevent or affect participation? If yes, please provide details: *

I have read and accepted the Term and Conditions laid out on our website *

I have read and accept our privacy policy and GDPR statement laid out on our website *

Please print and sign, or digitally sign, the Code of Conduct found on our website and email to admin@kingselitegoaltending.com *

By signing this form, you confirm that all information is accurate and correct; and you agree to all Terms & Conditions as detailed on our website. Please enter your name below (if under 18, must be signed by a parent/guardian) *