Colts Application Form (2015)
Colts Application Form (2015) Full Name Please refer to “Age Criteria” under Terms and Conditions Age Child Details Date of Birth Place of Birth Home Address Post Code Home Tel No. Name of School Year Parents / Guardian Details NOTE: Do not provide child’s email or mobile number Gaam Name of first contact and relation Relation First contact Mobile No. First contact Email Name of second contact and relation Relation Second contact Mobile No. Second contact Email If your child has a medical condition we should know about please put details below: Colts Subscription: Payment by cheque only, payable to SKLPCC (non refundable) Colts Indoor ONLY (Jan to Apr) Colts Outdoor ONLY (Apr to Aug) Colts Full Season (Indoor & Outdoor) £120.00 £70.00 £190.00** (held at JFS School, Kingsbury*) (held at SKLPCC, Northolt) (* Any changes to venue will be communicated to parents prior to indoor starting) (** FULL SEASON available at a discounted rate of £180 for applications received before 13th December 2014) Please return all forms and payment to: SKLPCC Colts Academy Aashil Pindolia 12 Willowcourt Avenue, Harrow, Middlesex, HA3 8ES Tel: 07904 728 766 Email: aashil.pindolia@gmail.com SKLPCC Colts 2014 www.sklpcc.co.uk Private & Confidential Please delete where appropriate First Aid or Emergency Treatment I/We do/do not consent to basic first aid being given to my/our son/daughter should he/she sustain an injury whilst under the supervision of the Club. I understand that, should this occur, the Club will endeavor to contact a parent/guardian on the emergency given and also arrange further medical assistance if deemed necessary. I/We do/do not consent to my child receiving medical treatment that, in the opinion of a qualified medical practitioner, may be necessary. Photography and/or Video Recording I/We do/do not consent to video footage being taken in the interests of technical analysis to aid the coaching. I/We do/do not consent to other video (family records) being taken. I/We do/do not consent to the taking of photographs which may be used in Club promotional literature, on the Club's website or for press reports. All information provided on page one is correct and agreed to the information provided. We have read the Disciplinary Rules attached to this Registration and abide by the Clubs Rules and Regulations. Parent/Guardian - Print name: Signature: Date: Colts - Print name: Signature: Date: Please tick the box if you do not wish to be contacted about other Club information outside of the Colts Academy. Please ensure the Terms & Conditions / Disciplinary Rules have been read and signed by Parent/ Guardian and Child. OFFICE USE ONLY Indoor only U10 Outdoor only U11 Full Season U13 U15 U17 Amount paid (£) SKLPCC Colts 2014 www.sklpcc.co.uk Private & Confidential
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