Bingham Rangers Registration

Participants

First Name

Last Name

Date of Birth

Your Email

Parent/Carer

First Name

Last Name

Parent/Carer Email

Parent/Carer Mobile Number

Street Address

Address Line 2

City

Postcode

Does the participant have a medical condition?
YesNo

If yes, then please provide details

Consent for images to be taken?
YesNo

Consent to receive email updates about Bingham Rangers and other Bingham Town FC news?
YesNo