BTFC Soccer Schools December 2017

Christmas Break Thursday 21st & Friday 22nd December, 9am-3pm on all days

Places limited so book in good time, payment required to secure place on course.

Should you have any issues with booking please contact mike@brackleytownfc.co.uk

Please complete details below
Parent/Guardian Information
Parent/Gaurdian Name(*)
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House Number/Name(*)
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Road/Street(*)
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City/Town(*)
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County(*)
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Post Code(*)
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Email(*)
Please specify your email address.

Please make sure you enter your correct email address, you will not receive confirmation details otherwise

Home Phone Number(*)
Please specify your home phone number.

Do not include spaces

Mobile Phone Number(*)
Please specify your mobile phone number.

Do not include spaces

Emergency Contact (if different from above)
Name
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Phone Number best to contact you on
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Do not include spaces

Children's Details

Extra time club available, 3.00 - 4.00pm £5.00 on all days (pre-booking required)

First Child
First Childs Name(*)
Please specify your childs name.

First Childs DOB(*)
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First Childs School Year(*)
Please specify your childs school year

First Child days reserved

Tick only days required, if you want to book all three days then just tick 'All three days'

Days Booked First Child

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Extra Hour 3 - 4 First Child

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Second Child
Second Childs Name

Second Childs DOB
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Second Childs School Year
Please specify your childs school year

Second Child, days reserved
Days Booked Second Child

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Extra Hour 3 - 4 Second Child

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Child Safeguarding

Arrival of child/children

We strongly recommend that your child/children are accompanied by a responsible adult to the Soccer School each day

Collection of child/children

We strongly recommend that your child/children are collected by a responsible adult from the Soccer School each day

Select from options below

Collection of children(*)
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Parent/Guardian Name
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I the Parent/Guardian named above give my consent for my child/children (Named below) to leave unattended

Parent/Guardian/Responsible Adult Name
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Person named above will be the principle responsible adult who will pick up the child/children after the soccer school, if any there is any change to this the coach must be notified in writing as to the name of the responsible adult who will be collecting the child/children (named below), this confirmation will need to be handed to the coach on the day of course

First Childs Name(*)
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Second Childs Name
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Medical Info - for all children please state any relevant medical details, conditions, allergies, medication that you wish us to be aware of. E.g. asthma / epilepsy / physical. BTFC staff are not allowed to administer medication - if none state 'none'

Medical Information(*)
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Media Release - I allow my child/children to be photographed/filmed during the course by BTFC staff to be viewed by the public in conjunction with BTFC media outlets website, social media and promotions. If you select 'No' your child will not feature in any of the above.
Yes or No(*)
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Items marked with an * are required.
Total to pay
Total to pay
GBP - £0.00

Once form completed click on 'Confirm and pay for my order' below and you will be taken to 'PayPal' where you can pay through 'PayPal' or by Debit/Credit Card.

You will receive an automated email confirming your purchase

Thank you for your support BTFC

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