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

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