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Athletics Coaching and Activities in the Stratford on Avon Area

Spring Half Term 2017 Online Registration Form

Please enter all your details and either 

Pay online prior to the event via PayPal.  You will be given this option once you have completed and submitted the form.

or send a cheque prior to the event made payable to AStarCoaching to:

AStarCoaching
6 Fordham Avenue
Stratford-upon-Avon
CV37 6XD

or pay cash on the first day

The cost will be £30 for two days or £15 for one day.

An administration fee of £5 will be charged for any cancellation made within 2 weeks of the course.

Generated with MOOJ Proforms Version 1.3
* Required information.

Please tick the dates you require:

1st June
2nd June

  

First name of child (one child per form please) *
Surname of child *
Address Line 1 *
Address Line 2
Town *
Postcode *
Gender *
 Male
 Female
Age *
Date of birth *
School Year *
School (choose from list)
School (if not on list)
Name(s) of friend(s) attending the course
Name of Parent or Guardian *
Email address *
Home phone *
Mobile phone
Emergency contact number *

Photography/Filming may take place during StarTrack to promote and publicise the scheme.

Please indicate whether your child can be photographed or filmed *
Yes
No

 

Data protection: Your information will not be passed onto other organisations outside of Stratford on Avon AC.

 

Medical details / personal issues

You will need to have completed and returned this booking form prior to your child attending the first day,
which will give us emergency contact information and medical details.

If your child has an accident this booking form gives your authority, that on the advice of a qualified medical practitioner the Manager can approve such medical treatment as is deemed necessary in an emergency during the camp including anaesthetic, paracetemol or a blood transfusion where considered by medical authorities.

Please indicate details of any medical condition requiring specific medical treatment or which may require emergency treatment below:

Date of last Tetanus immunisation *
Name of family doctor *
Doctor's phone number *
Please tick any of these statements that apply:
My son/daughter suffers from allergies/asthma
My son/daughter has had a contagious disease in the last 3 months
My son/daughter has been ill recently
There are activities in which my son/daughter should not participate
My son/daughter takes regular medication
There is other information of which you should be aware
If you have ticked any of the above please explain in more detail. We would prefer to have too much information rather than too little.

  

Click here to read the programme details

I have read the programme details and consent to my child taking part *

  

I understand AStar Coaching will not accept liability for loss or injury *

  

Payment Method *
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