Registration

Please fill out the following registration form.

CHOOSE WEEKDAY & VENUE
all sessions are held between 4.00pm and 6.00pm

Mondays: Bridgefield, St. ThomasTuesdays: King George V Memorial Park, St. PhilipWednesdays: Checker Hall, St. LucyThursdays: Trents playing field, St. James

DEDICATED GOALKEEPING COACHING
all sessions are held on Sundays between 2.00pm and 4.00pm at FIFA approved UWI artificial turf football field at Paradise Park, The Lazaretto

yesno

CHOOSE AGE GROUP

5 - 10 years, born 2001 - 200611 - 14 years, born 1997 - 2000coaching team

Your first name (required)

Your last name (required)

Your gender (required) malefemale

Date of birth (required) Year Month Day

Email (required)

Phone Number (required)

Cell Number (required)

Street Address (required)

City, Parish (required)

ZIP code

Nationality

Club/Team

Medical condition, allergies, disabilities, medications (required):

NonePlease secify:

For every registered participant THE BREWSTER TRUST offers health insurance coverage with a special sport package for the duration of the programme. This includes for example accident medical, deductible, co-insurance factor and also maximum per visit to doctor’s office, hospital & home, specialist consultation benefits or physiotherapy. I request health insurance for my child/ward and contribute BDS$ 5.00 payable on the first weekday of participation in cash.

YesNo

I grant permission for my ward to participate in THE BREWSTER TRUST Football Autumn 2011 programme mobile coaching:

YesNo

I confirm that my child/ward is healthy and capable of participating in the programme and that any injury occurring during the programme is not covered by THE BREWSTER TRUST:

YesNo

I recognise that THE BREWSTER TRUST is not responsible for any accidents/losses occurring during the programme:

YesNo

I agree that any photographs or videos obtained from the programme are licensed for marketing and commercial purposes by THE BREWSTER TRUST:

YesNo

Additional comments

You will get a personal feedback confirming the receipt and participation within 24 hours.
technical annotation: in some web browsers the “working clock” doesn’t stop although the registration has been sent.