Inclusive Sport Event Player Registration - Oxford

Registration Details

Please complete this online form to register to participate in the following Powerchair Football Inclusive Sport event:

Date: Sunday, 26th July 2015
Time: 10am - 3pm
Venue: Oxford City Indoor Arena
Berinsfield,
Oxford,
OX10 7LN.

All equipment and coaching is provided. If you require any further information, please contact:
Adam McEvoy
WFA South Region Development Officer
E: adam.mcevoy@thewfa.org.uk
M: 07972 569 727

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* 1. Player details

First name:

Surname:

Email address:

Telephone number:

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* 2. Postcode:

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* 3. Gender:

Male

Female

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* 4. Date of Birth:

Date of Birth

Date

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* 5. Nature of Impairment / Condition

Muscular Dystrophy (all types)

Cerebral Palsy

Spinal Muscular Atrophy

Spina Bifida

Brittle Bones

Prefer to not answer

Other (please specify)

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* 6. Ethnicity:

White British

Other White British

White Irish

Other White Background

White and Black Caribbean

White and Black African

White and Asian

Other Mixed Background

Gypsy / Romany / Irish Traveller

Other Ethic Group

Indian

Pakistani

Bangladeshi

Chinese

Other Asian Background

Black Caribbean

Black African

Other Black background

Arab

Prefer not to answer

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* 7. Emergency Contact details

Emergency Contact Name:

Emergency Contact Telephone:

Relationship to Player (Parent, Carer etc)