Registration Form

Please complete the form below to register for the Non-Residential Darren Gough Sports Academy 6th – 10th August 2012. £250.00 per child.

Parent's Details

Parent's name^*

Address^*

City / town

County^*

Postcode/zip code^*

Country^*

Telephone (Please include area & country codes)^*

Email address^*

Child's Details

Name^*

Age^*

School

Sports club

County representation

Dietary requirements

Any other special considerations

Course Details

I am interested in the following sports ^*
Please rank all the sports you are interested in, in order of preference.

Cricket

Rugby

Hockey

Athletics

Tennis

Lacrosse

Swimming

Basketball

Soccer

I need kit provided

Yes

I am happy for my son/daughter to be filmed and/or photographed

Yes

* indicates required field

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