BRISTOL ROVERS COMMUNITY DEPARTMENT

February 2008 Booking Form


Name............................................................................

Address.........................................................................

................................................................................

Postcode........................................................................

Telephone.......................................................................

Date Of Birth ...../...../.....              Age.....              Gender  M / F 

School..........................................................................

Emergency Contact Name..........................................................

Emergency Contact Telephone.....................................................

Relevant Medical Details........................................................

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COURSES REQUIRED

[   ] Monday 18th February (£12)
[   ] Tuesday 19th February (£12)
[   ] Wednesday 20th February (£12)
[   ] Thursday 21st February (£12)
[   ] Friday 22nd February (£12)

[   ] All Five Days (£50)

I enclose a cheque for £..... made payable to "BRFC Community Dept".


CONSENT & AGREEMENT

I acknowledge and accept that the Bristol Rovers Community Department and its representatives shall not have any liability in respect of any injuries sustained by my child or in respect of any loss or damage occurring to my child’s belongings whilst attending any of the above events. In the event that my child is injured while attending any of the above events, and where both I and the emergency contact cannot be contacted, I hereby give consent for my child to receive any necessary medical treatment.


Print Name.......................................


Signed...........................................


Date.............................................