Inspire Registration Form

The Inspire Multi Sport Clubs have been funded by Aiming High to offer a fantastic opportunity to provide multi sport opportunities around the County.

Sport Across Staffordshire & Stoke-on-Trent have worked together with the following Councils to support the delivery of the Multi Sport clubs.

  • East Staffordshire Borough Council
  • Tamworth Borough Council
  • Stafford Borough Council
  • Newcastle Borough Council
  • South Staffordshire Council
  • Lichfield District Council

Before you can participate in the club, we require some additional information. Please complete this form before attending.

    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 list all of the people that will be attending the club:

    Attendee 1

    Name

    Category

    Date of Birth (dd/mm/yy)

    Disability

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

    Ethnic Group

    Ethnicity

    Photo Consent

    Attendee 2

    Name

    Category

    Date of Birth (dd/mm/yy)

    Disability

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

    Ethnic Group

    Ethnicity

    Photo Consent

    Attendee 3

    Name

    Category

    Date of Birth (dd/mm/yy)

    Disability

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

    Ethnic Group

    Ethnicity

    Photo Consent

    Attendee 4

    Name

    Category

    Date of Birth (dd/mm/yy)

    Disability

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

    Ethnic Group

    Ethnicity

    Photo Consent