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Goose on the Loose Football Registration form

PARTICIPANT DETAILS

Full Name

D.O.B

Gender

Gender
PARENT/GUARDIAN DETAILS

Full Name

Relationship to child

Relationship to Child

Address

Phone Number

Email

Location

Location
A
B
5 WEEK PROGRAM STARTING (04/07 South Holderness & 05/07 Haltemprice) followed by a 1 week break on 8th & 9th August

Payment choice

Payment choice
Payment of £25 to be made before start of each block and gets you access for the full 5 week block at your desired location.
No commitment to future blocks, If wanting to continue just simply make payment prior to new block
PAYEE / RECIPIENT DETAILS; GOTL CLOTHING LTD Sort code; 04-06-05 Account Number; 25868842
Reference; Childs Name
ASSUMPTION OF RISK/ RELEASE OF CLAIMS

I acknowledge risk and release GOTL Clothing LTD from liability of injuries, damages or issues arising (with exceptions for gross negligence)

I acknowledge risk and release GOTL Clothing LTD from liability of injuries, damages or issues arising (with exceptions for gross negligence)

Do you consent to your child's image being used on social media pages?

Do you consent to your child's image being used on social media pages?