BATTS JUNIOR OPEN LEAGUE REGISTRATION FORM

Please complete this form and make your payment of £24 to register one player in the BATTS Junior Open Table Tennis League. Our preferred method of payment is direct into our bank account [Sort Code 77-13-10 Account Number 23166968]. When paying online please include your surname in the reference. If you pay by cheque, please make it payable to BATTS and post to Graham Frankel 46 Mandeville Road Hertford SG13 8JQ

Closing date is 11th September 2016.

Player Details:

First Name / Surname
Address / Date of Birth
Sex (M/F)
Email
Post Code: / Phone

Disability:

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment which has a substantial long term effect on his or her ability to carry out normal day to day activities’

Do you consider yourself to have a disability? Y/N

If yes, what is the nature of your disability?

Medical Information:

Please detail below any important medical information that our Coach/First Aider should be aware of (E.g. epilepsy, asthma, diabetes etc) and any medication that they regularly take:

Parent/ Guardian Emergency Contact Information

Surname / First Name (s)
Tel No / Mobile No
E-mail
Address / Leave Blank if same as above / Post Code

Declarations:

-  If I am completing this on behalf of a minor, I agree to my son/daughter/child taking part in the BATTS Open League

-  I understand that photographic images may be taken for advertising and marketing purposes only.

-  I understand in the event of injury and illness, all reasonable steps will be taken to contact me or the alternative emergency contact and the qualified person will deal with the injury or illness in the most appropriate way.

-  I understand that I must inform the organiser immediately, if any changes occur to the details contained within this form.

NAME OF PARENT/CARER:..

SIGNATURE:...... DATE:......

[If you return this form by email you do not need to sign it, but receipt of your email will be taken as your confirmation]

PLEASE RETURN THIS FORM TO

YOUR ENTRY WILL BE CONFIRMED WHEN PAYMENT IS RECEIVED