PSi Kilkenny Clinic - October 2018
Clinic Registration Form

Venue: Kilkenny College
Cost:  €40
Dates: Thurs 1st & Fri 2nd November
Time: 9-12:30 4th/5th/6th Class Boys and Girls
Time: 12:30-2 1st/2nd/3rd Year Boys and Girls
Sign in to Google to save your progress. Learn more
Email Address *
Very important.  Please ENSURE that it is correct.  All correspondence will go to this email.
Secondary Contact Email address
If primary email does not work for some reason...
Player Particulars
Player's First Name *
Player's Surname *
Date of Birth *
Not 2018! Ensure correct year please.
MM
/
DD
/
YYYY
Age group attending
School *
1. Parent (or guardian) Full Name
2. Parent (or guardian) Full Name
Parent (guardian) Mobile Number *
Alternate contact number *
Other parent mobile preferably
Preferred Playing position *
Young indoor players will be required to play in all positions.  This is merely and indication of preferred playing position.  Goalkeepers need to bring their own kits.  Please click ONE of the options below only.
Required
Last school team represented *
Player Gender *
Participant waiver

14.1 I hereby authorize The Company or its representatives to obtain emergency medical treatment on behalf of my child in the event that, in the opinion of  The Company or its representatives, my daughter/son is in need of such treatment. I further agree that I will be responsible for the payment of any and all medical treatment, associated transportation costs or medicines of any nature which may arise in connection with any sickness or accident which may occur during the Event/League and/or Clinic , whether such expense is incurred during or subsequent to the Event/League and/or Clinic , and will indemnify and hold harmless the Event/Camp and/or Clinic and further release the Event/League and/or Clinic , or its representatives for any damages sustained by me in connection with providing of medical treatment.
I acknowledge and understand that The Company's Events/Camps and/or Clinics are privately run sports events and have no affiliation or partnerships with the venues and/or facilities at which they are operated. I agree to hold the Event / League and/or Clinic location, venue and/or host, its facilities, management and employees as well as The Company and its business partners, officers, agents, employees, coaches, chaperones and officials harmless from and against any and all claims for injury, costs, liability, damages or loss to person or property which may be sustained or occur while at Events / Leagues and/or Clinics, whether or not they are due to negligence and in consideration I give my consent for my child named on the application to participate in all sport activities at the Event / League and/or Clinic. Also, any damaged caused by my daughter/son to camp or facility property will be her/his responsibility to remedy or reimburse.
I hereby acknowledge that there is a risk of injury involved in sports participation. My daughter/son is physically fit and able to participate in strenuous activities and attend this Event / League  and/or Clinic.

*
NB CLINIC INFORMATION  (Please copy and save relevant details)
Venue: Kilkenny College
Dates: Thurs 1st & Fri 2nd November
Time: 9-12:30 4th/5th/6th Class Boys and Girls
Time: 12:30-2 1st/2nd/3rd Year Boys and Girls
Payment Method
COST FOR 2-day clinic:
€40

BANK DETAILS:

NAME: PSi Kilkenny Cats
IBAN: IE88 AIBK93 3198 5708 1160
BIC: AIBKIE2D
First time playing PSI *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy