*
First Name:
*
Surname:
*
Date of Birth:
Gender
Male
Female
*
Address:
*
Telephone Number(Daytime):
*
Email:
*
How would you describe your disability?
Learning difficulties
Physical impairment
Visual impairment
Hearing impairment
Multiple impairment
Other (please specify)
*
Team
Juniors (8-16)
Adults (16+)
How would you describe your ethnic origin?
White
Mixed
Chinese
White – British
White + Black Caribbean
Chinese
Irish
White + Black African
Other white
White + Asian
Other mixed
Asian/Asian British
Black/Black British
Other
Indian
Caribbean
Other
Pakistan
African
Refused
Bangladesh
Other Black
Other Asian
If you have any questions regarding the St. Ives Rangers Disability FC, please contact Paul Ashbridge on 01480 388842 or e-mail
paul.ashbridge@huntsdc.gov.uk
If you think a friend would like to use this application, please use our '
send to a friend
' form
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