Rise Hockey Academy Registration

Parent/Guardian 1

Parent/Guardian Name:

First Name

Last Name

Parent/Guardian Cellphone Number:

(###)

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EmailParent/Guardian Email:

Parent/Guardian 2

Parent/Guardian 2 Name:

First Name

Last Name

Parent/Guardian 2 Cellphone Number:

(###)

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Parent/Guardian 2 Email:

Next of Kin

Alternative contact in case of Emergency

Next of Kin:

First Name

Last Name

Next of Kin Cellphone Number:

(###)

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Child 1 Details:

Child 1 Name:

First Name

Last Name

Child 1 Name of School:

Child 1 Age Group:

Child 1: Would you like to order a Rise Sport Shirt:

Child 2 Details

Child 2 Name:

First Name

Last Name

Child 2 Name of School:

Child 2 Age Group:

Child 2: Would you like to order a Rise Sport Shirt:

Child 3 Details

Child 3 Name:

First Name

Last Name

Child 3 Name of School:

Child 3 Age Group:

Child 3: Would you like to order a Rise Sport Shirt:

Invoice Details

Person responsible for payment.

Name

First Name

Last Name

Invoice to be addressed to:

Email for Invoice:

Terms and Conditions

Terms & Conditions

I have read and agree to the Terms and Conditions.

I give permission to Rise Sport (PTY) LTD, for pictures and videos of my child to be used for social media, website and advertising purposes.

Yes