5v5 Disability Festival – Player Registration
5v5 Disability Festival Sunday 11th June 2017
St Ivo Outdoor Centre, St Ives
Please return completed form to [email protected]
Childs Name: .…………………………………………………..............
Address: ………………………………………………………………………………………………………………………………
Contacts Telephone number
Mobile: …………………………………………………….
Home: …………………………………………………….
Email (if you have one): ……………………………………………………………………………………………………….
Please advise us of any details, medial or otherwise, that you would like the coach to be
aware of. You should include details of any medication your child is taking:
……………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
Which disability do you consider your child/the participant to have? (please tick)
Visual impairment
Hearing impairment
Physical Impairment
Learning disability
Mental health
Autistic Spectrum Disorder
Other
It is essential we have an emergency contact number at all times. Please state any other
contact names and numbers you may feel are appropriate:
Name: ………………………………………………………
Number: ……………………………………………………
I am aware that the 5v5 festival will involve physical activity and will check with my doctor
before my child participates if I have any concerns about their ability to take part.
Parent/Carer
Signed: …………………………………………………….
Date: …………………………………………………………