Inspire Registration Form

Which Club/s will you be attending?

LichfieldStaffordNewcastleTamworthWombourneBurtonUttoxeterPenkridge

Parent's / Carer Name

House Name / Number

Street

Town / City

County

Postcode

Telephone Number

Mobile Number

Email Address

—Please choose an option—Disabled ChildSiblingParentCarer

Specific Learning DifficultyModerate Learning DifficultySevere Learning DifficultyProfound Multiple Learning DifficultyBehavioural, Emotional, Social DifficultySpeech, Language, Communication NeedsAutistic Spectrum DisorderVisual ImpairmentHearing ImpairmentPhysical DisabilityOther

—Please choose an option—WhiteMixedAsian or Asian BritishBlack or Black BritishOther Ethnic Group

—Please choose an option—White BritishWhite IrishTraveller of Irish HeritageAny other White BackgroundGypsy/RomaWhite & Black CaribbeanWhite & Black AfricanWhite & AsianAny other Mixed BackgroundIndianPakistaniBangladeshiAny other Asian BackgroundCaribbeanAfricanAny other Black BackgroundChineseAny other Ethnic GroupRefused

—Please choose an option—Press Release, SASSOT Publications, Website etc OnlySASSOT Social Media Pages (Facebook, Twitter) etc OnlyFull Photo ConsentNo Photo Consent

—Please choose an option—Disabled ChildSiblingParentCarer

Specific Learning DifficultyModerate Learning DifficultySevere Learning DifficultyProfound Multiple Learning DifficultyBehavioural, Emotional, Social DifficultySpeech, Language, Communication NeedsAutistic Spectrum DisorderVisual ImpairmentHearing ImpairmentPhysical DisabilityOther

—Please choose an option—WhiteMixedAsian or Asian BritishBlack or Black BritishOther Ethnic Group

—Please choose an option—White BritishWhite IrishTraveller of Irish HeritageAny other White BackgroundGypsy/RomaWhite & Black CaribbeanWhite & Black AfricanWhite & AsianAny other Mixed BackgroundIndianPakistaniBangladeshiAny other Asian BackgroundCaribbeanAfricanAny other Black BackgroundChineseAny other Ethnic GroupRefused

—Please choose an option—Press Release, SASSOT Publications, Website etc OnlySASSOT Social Media Pages (Facebook, Twitter) etc OnlyFull Photo ConsentNo Photo Consent

—Please choose an option—Disabled ChildSiblingParentCarer

Specific Learning DifficultyModerate Learning DifficultySevere Learning DifficultyProfound Multiple Learning DifficultyBehavioural, Emotional, Social DifficultySpeech, Language, Communication NeedsAutistic Spectrum DisorderVisual ImpairmentHearing ImpairmentPhysical DisabilityOther

—Please choose an option—WhiteMixedAsian or Asian BritishBlack or Black BritishOther Ethnic Group

—Please choose an option—White BritishWhite IrishTraveller of Irish HeritageAny other White BackgroundGypsy/RomaWhite & Black CaribbeanWhite & Black AfricanWhite & AsianAny other Mixed BackgroundIndianPakistaniBangladeshiAny other Asian BackgroundCaribbeanAfricanAny other Black BackgroundChineseAny other Ethnic GroupRefused

—Please choose an option—Press Release, SASSOT Publications, Website etc OnlySASSOT Social Media Pages (Facebook, Twitter) etc OnlyFull Photo ConsentNo Photo Consent

—Please choose an option—Disabled ChildSiblingParentCarer

Specific Learning DifficultyModerate Learning DifficultySevere Learning DifficultyProfound Multiple Learning DifficultyBehavioural, Emotional, Social DifficultySpeech, Language, Communication NeedsAutistic Spectrum DisorderVisual ImpairmentHearing ImpairmentPhysical DisabilityOther

—Please choose an option—WhiteMixedAsian or Asian BritishBlack or Black BritishOther Ethnic Group

—Please choose an option—White BritishWhite IrishTraveller of Irish HeritageAny other White BackgroundGypsy/RomaWhite & Black CaribbeanWhite & Black AfricanWhite & AsianAny other Mixed BackgroundIndianPakistaniBangladeshiAny other Asian BackgroundCaribbeanAfricanAny other Black BackgroundChineseAny other Ethnic GroupRefused

—Please choose an option—Press Release, SASSOT Publications, Website etc OnlySASSOT Social Media Pages (Facebook, Twitter) etc OnlyFull Photo ConsentNo Photo Consent