Post Code:

Date of Birth:

Age on the day:

Gender: Male Female

Home Telephone:

Emergency Contact name:

Emergency Contact Number:

Relationship to Player:

Email Address:

Medical Conditions: Yes No

If Yes, Please Specify:

Please select which camp dates you would like to attend:

Feb 16th
Feb 17th
April 2nd
April 3rd
June 7th
June 8th
July 23rd
July 24th
August 20th
August 21st
October 22nd
October 23rd

MEDICAL CONSENT

In the case of injury or illness I herby give my consent for the coaching/medical staff at Katz Keepers too authorise medical treatment for my child should they require it including the application of plasters. I have provided Katz Keepers with information regarding any existing medical conditions/allergies that they should be aware of.

Medical Consent Given

PHOTOGRAPHY

Katz Keepers occasionally take photos at the Goalkeeping camps of the training sessions in progress. The photos taken are of group shots and not individual players and are used only on the Katz Keepers website and for some promotional adverts in various football handbooks.

Photography Permission given

Football and goalkeeping in particular can be a fairly physical sport. Please be aware that by submitting this application form you accept that the child named above can take part in the coaching, games and activities at Katz Keepers Goal Keeping Camps totally at their own risk and you will not hold Katz Keepers liable in any way whatsoever.

Method of Payment:

PayPal (A request for payment by PayPal will be sent to your email address in due course)

Pay on the day (Cash or cheque only)