SportsEdu Registration – Team Nigeria UK

E-Learning

E-Learning Registration Form

Kindly fill the form below to register for any of our E-Learning Programs with Southampton FC

Candidate's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Country

Organization

Designation

Telephone (Work) *

Mobile (WhatsApp) *

Email *

Instagram

Date of Birth

What are you interested in *

Emergency Contact/ Next of Kin

Next of Kin Name *

First

Last

Next of Kin Address *

Next of Kin Phone Number *

Next of Kin Email *

Relationship

Medical Information

Is the player recieving any medical treatment? if yes, kindly provide details below

Please provide a summary of your work experience below

PARENTAL CONSENT

This MUST be completed by the candidate and their parent, or sponsor if the candidate is under 18

Declaration

I being the parent/sponsor of the above named hereby give my consent to my ward taking part in TNUK/FC coach education activities. I accept that the information provided in this form may be shared with the SFC in order to create a statistical record or future promotions related to TNUK/SFC activities .Photos taken and video recordings of my ward during the activity maybe used in the dissemination of the activity.