Football Halaqa Registration

Name of Player 1

First

Last

Name of Player 2

First

Last

Age Group 1

8-13

Age Group 2

14-16

Anything we need to know?

Allergies or disabilities

Emergency Contact

Please provide an alternative contact person in case of emergency. Emergency contacts must be over the age of 18 and capable of caring for the child if you are unavailable.

Emergency Contact's Name

First

Last

Emergency Contact's Phone Number

Emergency Contact's relationship to the child

Are you happy to contribute £10 towards the cost of this event?

This contribution is optional All our youth events have costs like pitch hire, food and resources. We would like to not have to charge these expenses to the Mosque so please help us continue to run these events. Donate using this link https://www.southendmosque.org/donations/youth/

Payment

One Player Registration Per Week

Price: £8.00

Total

£0.00

Football Halaqa Registration

Emergency Contact

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