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Please enter firstname Please enter surname Please enter date Please enter date Please enter your address Please enter town/city Please enter post code Please enter email address Please enter main telephone number Please Select organisation type Please enter name of school/club/organization Please enter Town/City Please enter organisation addres Please enter organisation postcode Please enter password Please enter confirmpassword

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Personal Details

Title:

First Name: *

Surname: *

Date of Birth: *

Parential consent: *

Parental Email: *

Address Line 1: *

Address Line 2:

Address Line 3:

Town/City: *

County:

Postcode: *

E-mail Address: *

Main Telephone Number: *

Mobile:

Please tick the box that best describes your ethnicity: White British
White Irish
White Other
Mixed – White and Black Caribbean
Mixed – White and Black African
Mixed – White and Asian
Mixed – Other
Asian or Asian British – Indian
Asian or Asian British – Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British – Other
Black or Black British – Caribbean
Black or Black British – African
Black or Black British – Other
Chinese
Other Ethnic Group

Please tick to indicate any learning or physical disabilities: Deaf
Visually impaired
Hearing impaired
Physical disability
Learning disability
Multiple disability

Where did you hear about Quicksticks?:

Organisation Details

Type * School Club Organisation None

School Type
State Independent

Primary school Middle school Secondary school Special school

Name of school/club/organisation *

Address Line 1: *

Address Line 2:

Address Line 3:

Town/City: *

County:

Postcode: *

Email Address:

Main Telephone:

Your Main Role:

Hockey Activity

In your organisation do you currently offer any hockey activity?: Yes No Don't Know

Please tick what hockey activity you offer : Within Curriculum time
Extra Curriculum

Please tick all year groups / ages to which you deliver hockey : KS 2 (age 7-11)
KS 3 (age 11-14)

Create Password

Password: *

Confirm Password: *

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