Booking Form - Purely Sport Coaching
BILLINGSHURST SUPER SATURDAY 10 WEEK BOOKING FORM: 14th FEBRUARY – 25th APRIL 2015 Excluding Saturday 4th April 2015 CHILD’S NAME........................................................................................................................ PLEASE NOTE THAT SESSIONS RUN FROM 9:30 – 10:30 PLEASE TICK MAXIMUM GROUP SIZE GROUP AGES / DESCRIPTION SPORT Minis 3 and 4 year olds Football 12 Juniors 5 and 6 year olds Football 16 COST: £50 FOR BLOCK OF 10 WEEKS PLEASE ENTER THE FOLLOWING DETAILS IN FULL: Child’s D.O.B:......................................................................................................... Contact Name:..............................Emergency Number:........................................ Address:................................................................................................................. ............................................................................................................................... ......................................................Postcode:......................................................... Email:..................................................................................................................... School:................................................................................................................... Medical Conditions:............................................................................................... Parent’s Declaration: I hereby acknowledge agreement that the above named child is taking part in a Purely Sport Coaching course. Please sign and print below to ensure your child is covered by the Purely Sport insurance policy. PARENT / GUARDIAN NAME:........................................SIGNATURE................................................. POSTING THIS FORM?: Purely Sport Ltd, 8 Lakers Meadow, Billingshurst, West Sussex. RH14 9NP Please make cheques payable to: ‘Purely Sport Ltd’ From time to time, Purely Sport Ltd may wish to inform you of upcoming activities. Your details will not be passed on to any third parties. Please tick this box if you DO NOT wish to receive future mailings from Purely Sport Ltd Purely Sport take photographs of players during the coaching sessions and after trophy presentations, Please tick this box if YOU DO give permission for photographs featuring your child to be used in promotional material during this, and subsequent courses. www.purelysport-coaching.com Office use: Amount £...... tel: 0844 736 1502 Payment method: Cash / Cheque [email protected] Date of payment: ..../..../....
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