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