Booking form

* Required fields exist on this form
Child's Details

Child's First Name

Child's Preferred Name

Child's Last Name

Child's Gender

Child's Date of Birth
/ /

Child's School

Child’s current School year

Child's Club (If Applicable)

If your child it participating in 'Performance Rugby' please complete the fields below.

Preferred Position

Playing Strengths (Technical, Tactical, Physical)

Areas to develop (Technical, Tactical, Physical)

Parents Details

Parent/Guardian Title

Parent/Guardian First name(s)

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Contact telephone number: (with international dialing code)

Parent/Guardian Mobile Telephone

Address

Flat/house number or name and road

Town/City

County

Post code

Country

If UAE please select City

Invoice Address
Yes No

Invoice FAO

Invoice Flat/house number or name and road

Invoice Town

Invoice County

Invoice Country

Invoice Post Code

Child's Medical Information

Does your child suffer from any regular medical condition which may require treatment during the course?
Yes No

Medical Condition Details

Will your child will be taking any Medication during the course? (including for Asthma/Hay Fever)
Yes No

Please list the Medication Dose & Frequency

Does your child suffer from any Allergies?
Yes No

Allergies Details

Does your child have any special dietary requirements?
Yes No

Dietary requirements Details

Has your child been vaccinated against tetanus?
Yes No

Date of last Injection and of booster if applicable.

Your Child's Doctors Name

Doctors Telephone Number

Declaration

How did you hear about the Course?

I declare that the information I have provided is correct and accurate to the best of my knowledge at the time of completing this application and that I have read the Terms and Conditions

I also agree to Authorisation of Medical and Dental treatment being given to my child if required.

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Booking form

Child's Details

Parents Details

Address

Child's Medical Information

Declaration