Rise Hockey Clinic Registration

Parent/Guardian Name:

First Name

Last Name

Parent/Guardian Cellphone Number: *

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Parent/Guardian 2 Name:

First Name

Last Name

Parent/Guardian 2 Cellphone Number:

(###)

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Next of Kin: *

First Name

Last Name

Next of Kin Cellphone Number: *

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Child 1 Name: *

First Name

Last Name

Child 1 Session Attending: *

Monday 14 July

Tuesday 15 July

Wednesday 16 July

Child 2 Name:

First Name

Last Name

Child 2 Session Attending:

Monday 14 July

Tuesday 15 July

Wednesday 16 July

Child 3 Name:

First Name

Last Name

Child 3 Session Attending:

Monday 14 July

Tuesday 15 July

Wednesday 16 July

Name *

First Name

Last Name

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

No