Dear Parent/ Guardian s7

SUMMER CAMP 2016

BOOKING FORM

Date : Wednesday 23rd, Thursday 24th and Friday 25th August 2016

Venue : Trojans Club, Stoneham Lane
Cost : £75
(payable to Trojans Youth Rugby. Please include participants name and age on the reverse of the cheque)

Member of Trojans Club : YES/NO

Participants Name…………………………………..…………………
DOB : ...... Male/Female (delete as appropriate)

Age group (season 16/17, please circle) : 7 8 9 10 11 12 13

Address…………………………………………………………………………………………......

Email Address : ......
Please indicate any special requirements……………………...... ………..……………………......

......

Please indicate any medical requirements……………………………………………………......

……………………………………………………………………………………………………...………………………………………………………………

Emergency Contact Details:

Name : ………………………………………………………………………… Contact Number : …………………………………………....

Consent :

- In the event of an emergency, I agree to first aid being administered if needed,

- give consent for my son/daughter to attend the Summer Camp

- take responsibility in ensuring that he/she arrives at the venue and returns home from the venue safely.

- I give permission for Trojans RFC to take and use images and/or films of my child to be used in displays and promotional material. I have noted that I can withdraw my consent in writing at any time if a specific use causes concern.

Signed : (Parent/ Guardian) Date : ………………………….

Name (in capitals please)………………………………………………………
Please send completed forms and payment to : Sandra Coffin 14, Sherley Green, Bursledon, Southampton, Hampshire SO31 8FL or contact me on 07913 797739 / 02380 560412

#proudtobeaTrojan