You must be aged 18+ to complete this form. Parents/Guardians must complete this form for anyone under the age of 18

Player Details

Gender*:MaleFemale

Date of Birth*: (in some browsers, reqd format is yyyy-mm-dd)

Age*:

Nationality (required)

Ethnicity:

School Name (if applicable or N/A)

School Year as of Sept 2018 (if applicable or N/A)

Player Email (required)

Player Phone Number (required)

Parent/Guardian Name (required)

Parent/Guardian Email (required)

Parent/Guardian Phone Number (required)

Address




Do you consider yourself to have a disability?

Other Details:
(Medical conditions, dietary requirements, allergies etc, if none add N/A)

How did you hear about us?*:

Please advise if you have any objections to the player being included in promotional photography or videos relating to the club. Answer*:

I would like to receive updates about upcoming news and events and club information from City of Birmingham Rockets Basketball Club via,
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