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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
info@purelysport-coaching.com
Date of payment: ..../..../....