<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Active and Able Sports Club Registration Form

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Active and Able Sports Club Registration Form

Please enter your details to register and you will be contacted by an Access Point Organiser.
Just fill in the form below and then click on the Submit button. Boxes marked with a * are required.
First name
Surname
Date of Birth
Name of carer
Gender Male Female
Address
Post Code
Telephone number
Mobile number
Email address
Confirm email address
How would you describe your child's disability

Learning difficulties
Physical impairment
Visual impairment
Hearing impairment
Multiple impairment
Other (please specify)

Describe and additional help they may need while participating
Is there any medical information that we may need? (e.g. epilepsy, asthma, etc)
Do you agree to having your name and contact details added to a mailing database for future events Yes No
How would you describe your ethnic origin
White White – British
Irish
Other white
Mixed White + Black Caribbean
White + Black African
White + Asian
Other mixed
Asian/Asian British Indian
Pakistan
Bangladesh
Other Asian
Black/Black British Caribbean
African
Other Black
Chinese Chinese
Other Other
Refused
Are you a member of any of the 5 leisure centres in Huntingdonshire Yes No
Would you like to become a member (FREE)? Yes No

If you think a friend would like to use this application, please use our 'send to a friend' form

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