SEAHORSES REGISTRATION FORM CHILD 1 - Instonians Rugby Belfast

Seahorses Mini & YouthRugby Registration Form 1 Child P1 - P7, U12, U14, U16, U18

STANDARD PARENTAL / GUARDIAN CONSENT FORM Anything written on this form is confidential. Our coaches need to know these details in order to meet the specific needs of your childI give my permission for my child to attend for training and playing sessions ( PLEASE USE GOOGLE CHROME ).

CHILDS NAME*

DATE OF BIRTH.*

AGE*

Year Group Minis U5-U11's*

SCHOOL ATTENDED:*

DETAILS OF ANY KNOWN ALLERGIES, CONDITIONS, MEDICATION:

HOME ADDRESS*

ADDRESS LINE 2

CITY*

COUNTY

Postal Code*

PARENT / GUARDIANS NAME 1*

PARENT / GUARDIANS NAME 2

GUARDIAN PHONE

GUARDIAN PHONE 2

GUARDIAN EMAIL*

GUARDIAN EMAIL 2

GP NAME*

GP PHONE

I will inform of any important changes to my child’s health, medication or needs .

YES

I will inform of any changes to the addresses or telephone numbers given.

YES

SIGNATURE*

I AGREE TO THEE TERMS AND CONDITIONS*

Yes

GUARDIANS NAME*

Date*

AMOUNT*

£95

CARD HOLDERS NAME*

CARD NUMBER*

Please Select

Please select
January
February
March
April
May
June
July
August
September
October
November
December

Expiration Month*

Please Select

Please select
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049

Expiration Year*

CVC*

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