Wall Heath, Kingswinford, DY6 0AW

Individual Registration

Please enter information in the form below to process registration for event Kewford Player Registration - Pay & Play.

Player's Full Name *

Phone *

Email *

Medication Details

This includes details of any medication that Parents/Guardians may be on.

Player Medication *

Yes

No

Player's Medication Name

Player's Dosage

Player's Medication Frequency

Does player have any communication needs?

Emergency Contact Details

This includes where a scenario where one parent falls ill.

1st Emergency Contact Name *

1st Emergency Contact Number *

Add Another Emergency Contact?

Yes

No

2nd Emergency Contact Name

2nd Emergency Contact Number

Religion & Culture

Does the player have any religious or cultural requirements?

Yes

No

Relevant Details

Are there any guidelines we should follow to try to support the player?

By not agreeing to consent, the registration will not be complete. Please discuss this further with your team's point of contact. You can return to this form once any additional discussions have been had.

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Individual Registration

Medication Details

Emergency Contact Details

Religion & Culture

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