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SoccerRockz registration form
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Email *
Child's full name *
Date of birth *
MM
/
DD
/
YYYY
Child's school year SEPTEMBER 2023 (0 for reception) *
Home address *
Emergency contact *
E-mail
Name of parent (next of kin) *
Contact number *
Medical information including asthma, diabetes, epilepsy. *
What can trigger the asthma *
Is your child taking any prescribed medication *
Details of any serious illness/injury in the last 2 years *
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 *
Photograph/video consent for SoccerRockz promotional purposes *
Required
SoccerRockz Ltd
Registered in England: Company Number 096553569
Registered Office: 53 Warwick Street, Earlsdon, Coventry, CV5 6ET
A copy of your responses will be emailed to the address you provided.
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