Registration form – HOME OF YOUNG CHAMPIONS

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Prefix

Player's First Name

Middle Name

Last Name

Date of Birth

GenderMaleFemaleOther

School Attending

Admission/Student Number

Class / Grade

Parent/Guardian Full Name

Select

Parent/Guardian Phone+254

Parent/Guardian Email

Medical Conditions / Allergies/Previous Injuries

Doctor’s Contact

Emergency Contact Name

Select

Emergency Contact Phone Number+254

AgreementI confirm that the information provided is correct.

Parental ConsentI confirm the above information is accurate and give permission for my child to participate.I consent to initial medical treatment in case of emergency.

Parent/Guardian SignaturePlease type your full name as your signature.

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