Andrew Barratt
Corporate Director – Growth, Assets & Environment
Please ask for: Business Support
Direct dial:01827 709445
E-mail:
APPLICATION FOR USE OF A FOOTBALL PITCH 2016/17
FRIENDLY MATCHES
Only applications made on this form will be considered.
If, having completed this form and been allocated a pitch, the booking is subsequently not taken up an administration fee of £20 will be levied.
FEES AND CHARGES
Friendly in SeasonAnkerValley (with changing room facilities x 2) / Adult
Jnr / 52.00
33.00
Other Local Authority Pitches with no changing facilities available / Adult
Jnr / 43.00
31.00
Name of Club: ......
Name of Applicant:......
Address:......
......
Telephone Number :......
Email: ………………………………………………………………………………………………………..
Age group of players (under 16 yrs):......
Do you require changing facilities:*Yes/ No
Date pitch required: ……………………………. Time ……………………………………
Date pitch required ………………………………… Time ……………………………………
Date pitch required ………………………………… Time …………………………………….
Application on this form signifies acceptance of the application process and attached Conditions of Hire and Code of Conduct.
On submission of fully completed application pitch availability will be checked, booking will then be confirmed and payment will be required.
For new applications and renewals please send your payment to Environmental Management, Tamworth Borough Council, Marmion House, Lichfield Street, Tamworth, Staffordshire, B79 7BZ, in person or by post with a cheque, postal order or money order made payable to Tamworth Borough Council. Please note cash payments are no longer accepted. Payment can also be made online by visiting and clicking on “Pay it Online” then “Make a payment online here” then select “Miscellaneous Payments” then select “Football pitches” from the first drop down menu then the type of payment from the second menu and continue through the form.
Signed:...... Position In Club: ......
Date:...... Please confirm you are over 18:....Yes / No
I/We agree that Tamworth Borough Council may keep details resulting from this application in its records for the purpose of processing this application and relevant secondary application as required. Any information held may be disclosed to, recorded by and used by any party authorised by Tamworth Borough Council.
I am aware that, under the Data Protection Act, I may inspect any information held by Tamworth Borough Council relating to myself.
FOR OFFICE USE
PITCH AVAILABILITY CHECKED DATEDATE PITCH NO
DATE PITCH NO
DATE PITCH NO
AVAILIBILTY CONFIRMED TO APPLICANT DATE
PAYMENT RECEIVED – AMOUNT DATE
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