the application form
Transcription
the application form
OXFORD UNITED COMMUNITY DEVELOPMENT COURSES VENUE: St Gregory’s School AGES: 4–11 years COST: £45 DATES: Tuesday 13th January – 24th March TIMES: 5pm–6pm VENUE: Witney Leisure Centre AGES: 4–11 years COST: £45 DATES: Tuesday 13th January – 24th March TIMES: 5pm–6pm VENUE: Bicester Sports Centre AGES: 4–11 years COST: £45 DATES: Friday 16th January – 27th March TIMES: 5.30pm–6.30pm VENUE: Marston Ferry Sports Centre AGES: 4–11 years COST: £45 DATES: Saturday 17th January – 28th March TIMES: 9am–10am • FA QUALIFIED COACHE S• FREE TICKETS TO WATC H OXFORD UNITED • PLAYER VISITS • HAVE FU N AND IMPROVE YOUR FO OTBALL SKILLS • BOYS AND GIRLS OF AL L ABILITIES • AGES FROM 4–11 YEARS OLD 01865 337 525 - [email protected] WWW.OUFC.CO.UK APPLICATION FORM Please return to... Chris Lowes, Oxford United Community Department, Grenoble Road, Oxford, OX4 4XP Please reply as soon as possible to apply for a place. Any queries please contact E: [email protected] or T: 01865 337525 (PLEASE USE BLOCK CAPITALS) APPLICANT’S NAME: CHOICE OF VENUE(S): I WISH TO PAY BY: CREDIT CARD: Please charge my: Credit Card: Visa: Delta: BY CHEQUE: Debit Card: Mastercard: Euro Card: BY CASH: (tick as appropriate) Switch: Name on Card: Card Number: Issue No.: Security Code: Expiry Date: Valid From: HOME ADDRESS: POST CODE: E-mail: HOME TEL NUMBER: MOBILE: SCHOOL YOU ATTEND: DATE OF BIRTH: AGE (At time of course): WE MAY TAKE PHOTOS OF OUR COURSE PARTICIPANTS. PLEASE TICK TO ALLOW STAFF TO TAKE PHOTOGRAPHS OF YOUR CHILD FOR PROMOTIONAL MATERIAL DO YOU CONSENT TO ANY EMERGENCY TREATMENT THAT MAY BE REQUIRED. YES: NO: Any illness/disabilities we should know about? Please enclose a self-addressed stamped envelope to confirm place CHEQUES PAYABLE TO OXFORD UNITED YOUTH & COMMUNITY We understand that Oxford United Youth & Community Trust and the organisation providing the facility, are not under any liability whatsoever in respect of personal loss or damage however it is caused, whilst attending the course. PLEASE STATE HOW YOUR CHILD WILL GET HOME... Pick up from course venue: SIGNED Making own way home: (PARENT/GUARDIAN) www.justgiving.com/oufc-youthandcommunitysportstrust For booking conditions please see our website:www.oxfordunited-yc.co.uk or call our administration office on 01865 337525