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HTAFC XMAS SOCCER SCHOOLS!

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for ages 5 to 14 year olds

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all staff are qualified coaches, CRB and First Aid qualified

at The Zone Huddersfield Community Trust

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30 per two days booked
40 pay on day (per two days)

5 to 14 year olds (both camps) 9 am to 5 pm Football Sessions!

27th/28th December 2012

3rd/4th January 2013
at The Zone Huddersfield Community Trust
Off ST Andrews Road - HD1 6PT

ENJOY XMAS PLAYING FOOTBALL!

Bookings and information

rob.day@thezone.uk.com 01484 484134

facebook.com/thezonehct
twitter.com/thezonehct

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APPLICATION FORM CAPITAL LETTERS REQUIRED

Child Details

Xmas Camp (December, January or both) ......................................................................

Child Address ...........................................................................................................................
......................................................................................................................................................
Postcode ....................................................................................................................................
Child's name ..............................................................................................................................
Date of Birth .......................................................... Age.....................
Male / Female .......................................................................................
Medical issues .......................................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................................................................

Parent / Guardian Details

Name ................................................................................................................................................
Email .................................................................................................................................................
Adress ..............................................................................................................................................
............................................................................................................................................................
Postcode ..........................................................................................................................................
Contact numbers: Day..................................................................... Night ..............................................................

Payment Details

Credit / Debit Card: Solo [ ] Maestro [ ] Visa [ ] Mastercard [ ] (please tick)

Card number .........................................................................................................................

Expiry Date ......... / .......... Security Number (on reverse of the card) ...................
Valid From (Maestro / Solo only) .......... / .......... Issue Number ...............................

Card Holder's Signature ........................................................................ Date ...............................................

[ ] I enclose a cheque / postal order made payable to Huddersfield Community Trust
Please print address and course reference on the back of your cheque.
Total Amount: ...........................
If my son / daughter is injured and I cannot be contacted, I hereby give my consent for my son / daughter to receive medical
attention: YES / NO
I agree that The Zone HCT venue are NOT liable for any loss, damage or injury: YES / NO
I agree that The Zone HCT can take photographs for publicy purposes: YES / NO
Please note - once you have returned your application form you will NOT receive confirmation.

SIGNED ......................................................................................................

Mail to:The Zone Huddersfield Community Trust

Off St Andrews Road, Huddersfield, HD1 6PT