Request edit access
SoccerRockz registration form
Child's full name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Child's school year from Sept 2019 *
Your answer
Home address *
Your answer
Emergency contact *
Your answer
E-mail
Your answer
Name of parent (next of kin) *
Your answer
Contact number *
Your answer
Medical information including asthma, diabetes, epilepsy. *
Your answer
What can trigger the asthma *
Your answer
Is your child taking any prescribed medication *
Your answer
Details of any serious illness/injury in the last 2 years *
Your answer
If I cannot be contacted on the above numbers, I hereby give my consent for my child to receive medical attention *
Does you child have any learning difficulties or special needs *
Your answer
Photograph/video consent for SoccerRockz promotional purposes *
Required
Preferred training location *
SoccerRockz Ltd
Registered in England: Company Number 096553569
Registered Office: 53 Warwick Street, Earlsdon, Coventry, CV5 6ET
Submit
Never submit passwords through Google Forms.
This form was created inside of Soccerrockz.com. Report Abuse