Application Form
Sports Academy 2015
Contact Details & Home Congregation
Full Name:
_
Home Address:
_
Post Code:
Home Tel No:
Email:
Mobile No:
Date of Birth:
Home Congregation:
Name of Minister:
Please say something about how you are involved in your local congregation
What sports do you play and have you any coaching experience and qualifications?
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Tell us why you would like to attend Sports Academy 2015
If you are under 18 please tick this box and ask your parent or guardian to complete this section of the
form.
I agree for my child
to attend Sports Academy on
21-26 August 2015 in Richhill Presbyterian Church, Co. Armagh and to participate fully in all the activities.
Signed
Print Name_
Relationship to child
_
In case of emergency I may be contacted on Home:
Mobile:
If am unavailable please contact Name
Phone:
Relationship to child
Please indicate medical conditions, special needs, allergies or dietary requirements relevant to your
child, any medication being taken and anything else that would be helpful for the leaders to know
about:
Please tick the box if you are over 18 and will have access to a car with adequate insurance for the time
you are at Sports Academy (you will not be transporting young people just team members).
Please circle T-Shirt size:
S
M
L
XL
When completed, please RETURN this Application Form and £25 / €25 to:
Sports Academy
CCLW Office Assembly Buildings
2-10 Fisherwick Place Belfast
BT1 6DW
t: +44 (0) 28 90417248 e: [email protected]
Cheques should be paid payable to ‘Presbyterian Church in Ireland’ (Please do not send cash)