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Registration
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Student
First Name
Surname
Gender
Please Choose
Unspecified
Male
Female
Address:
Emergency Contact Information:
What school year is your child in? (For school clubs)
Medical Conditions - Please provide details of any medical information our coaches should be aware of:
Other (please provide details in the next section)
Severe Headaches
Heart Condition
Fits/Fainting/Black Outs
Not applicable
ADHD
Allergies
Anaphylaxis
Asthma/ Bronchitis
Autism
Diabetes
Epilepsy
Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months. If "Yes", please indicate your disability:
Please indicate whether you are happy to be contacted in relation to news, events, camps etc in the future by the Cobras Basketball Club:
Please Choose
No
Yes
None
Please indicate whether you consent for your child to appear on social media/advertising:
Please Choose
No
Yes
None
Have you ever played basketball before?
Please Choose
Yes
No
None
Ethnicity - In order to help the club monitor its membership, please will you tick one of the following boxes to identify your ethnic group/origin?
Please Choose
Black or Black British - Any Other Background
Prefer not to answer
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Any Other Asian Background
Black or Black British - Caribbean
Black or Black British - African
Gypsy or Irish Traveller
White British
White Irish
Any Other White
Mixed White and Black Caribbean
Mixed White and Black African
Any other Mixed or multiple ethnic background
Any other ethnic group
None
Customer
First Name
Surname
Email
Password
Password confirmation
Please indicate whether you consent for your child to appear on social media/advertising:
Please Choose
Yes
No
None
Please indicate whether you are happy to be contacted in relation to news, events, camps etc in the future by the Cobras Basketball Club:
Please Choose
No
Yes
None
Ethnicity - In order to help the club monitor its membership, please will you tick one of the following boxes to identify your ethnic group/origin?
Please Choose
Black or Black British - Caribbean
Any other ethnic group
Any other Mixed or multiple ethnic background
Mixed White and Black African
Mixed White and Black Caribbean
Any Other White
White Irish
White British
Gypsy or Irish Traveller
Black or Black British - Any Other Background
Black or Black British - African
Asian or Asian British - Any Other Asian Background
Asian or Asian British - Chinese
Asian or Asian British - Bangladeshi
Asian or Asian British - Pakistani
Asian or Asian British - Indian
Prefer not to answer
None
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