School Sports Programme:

Outreach Coaching Programme-Wushu Competition 2017

Application Form

School Name / :
Division# / : / Primary Secondary / Team Name:
Name of Teacher-in-charge / : / Tel No.:
Name of Team Leader / : / Tel No.:
School Address / : / Fax No.:
Email Address / : / Cheque No.:
Compulsory event# (choose one) / Optional routine#
(choose one fromQuanshu, plusJunior Jianshu (optional))
Quanshu / Jianshu
Movements of the Youth Wushu Badges Award Scheme Levels 1 to 2 / Movements of the Youth Wushu BadgesAward Scheme Levels 3 to 4 / Movements of the Youth Wushu BadgesAward SchemeLevels 5 to 6 / Wubuquan / Elementary Changquanstyle 1
levels 1 and 2 / Elementary Nanquan / JuniorJianshu
Name Of Participant / Sex / Year of Birth / Events# / Attention:
  1. Each student may only represent one team.
  2. All teams must take part in one compulsory event and perform one optional routine. (Optional routines are divided intoQuanshu and Jianshu routines. Each participating teammust choose one routine from Quanshu, plusJunior Jianshuif desired.)
  3. Please put a “” in the appropriate box.#
Declaration:
I hereby declare that all the information given above is true and correct. All participants aged under 18 have sought their parents’/guardians’ consent or authorised consent to their participation in the above activity. All team members are healthy, physically fit and suitable to participate in the above activity. The Organiser and the LCSD shall not be liable for the injury or death of any team members caused during the activity by their own negligence or inadequacy in health and fitness.
Compulsory event / Optional routine
Quanshu / Jianshu
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Signature of
Teacher-in-charge: / Date: / School Chop
Note:
(1)The information provided will only be used for purposes relating to enrolment in recreation and sports activities Organised by the Organiser and LCSD, future contact, compilation of statistics and opinion survey. Only those who are authorised by this the Organiser and LCSD will have the access to such information for the aforesaid purpose.
(2)For correction of or access to data provided on this form, please contact the staff of the LCSD on 2601 8861 or 2601 7613. You must provide the required personal data on this form. Failure to do so may result in the LCSD and the Organiser being unable to process your application.
(3)If there is any inadequacy in this prospectus, the Organiser reserves the right to amend it at any time without giving any prior notice.