Child Name (required)

Club (required)

Class and Year (required)

Age (required)

Post-Code (required)

Gender (required)
MaleFemale

Select Ethnicity
White/ White BritishBlack/ Black BritishAsian BritishMixed/ Mixed BritishOther

Specific Other:

Does your child have any known health conditions or injuries that may be brought on by sport or exercise?
YesNo

If yes please state:

Does your child suffer from any allergies or conditions that require medication?
YesNo

If yes please state allergy / condition and medication used:

Is there a special designated person at St Charles that administers this?
YesNo

If yes please state allergy / condition and medication used:

Does your child self administer E.G Asthma Pump?
YesNo

Do we have permission to take pictures / record to help with fundraising and reporting to the funders or for promotional material
YesNo

Emergency contact Name: (required)

Emergency contact Phone Number: (required)

Your Email (required)

Please tick this box if we can send you information and marketing relating to our clubs and activities