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Mind Gems Sports Application Form
An email address is required to complete this form. The option to pay for the activity is also available below and/or will be emailed to you upon completion of this form.
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* Indicates required question
Email
*
Your email
Name of Guardian
*
First and last name
Your answer
Name of Child
*
First and last name
Your answer
Child's Birth Date
MM
/
DD
/
YYYY
Please Provide 2 Emergency Phone numbers
*
Your answer
Which sport(s) are you interested in?
*
Soccer
Rugby
Basketball
Flag Football
Required
Please provide us with all allergy/health conditions your child has:
*
Your answer
Did you submit a physical form to the Director? If not, a physical form not older than 12 months must be submitted to the Director
*
Yes
No
Maybe
A copy of your responses will be emailed to the address you provided.
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