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)


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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: [email protected]
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