USC-Booking Form

Ultimate Soccer Coaching - Registration Form

Name Of Participant*

Age*

Address*

Email*

Parent/Guardians Name and Contact Number*

Emergency Contact 1

Emergency Contact 2

Please state any medical conditions or allergies

Please state any current medication being used

School Attending

Collection Details

Amount Paid*

Transaction ID from PayPal*

By clicking submit, you agree to our terms and conditions. Those labeled with a '*' are mandatory fields.
In the event that my son/daughter is injured whilst attending the course and I cannot be contacted on the above numbers, I hearby give my consent for my child to receive medical attention. I also give permission for basic first aid to be given (cuts,alings etc) I understand that the organisation or the authorities providing the facilities, their agents, servants and employees are not under any liability or obligation whatsoever in respect or personal injury, loss or damage however caused whilst my child attends the course.