G E T I N TO TH E Z O N E F O R F I TN E SS & F U N !

8 - 16
year olds

GYM ZONE

Half Term Camp!

Tuesday 19th February 2013
Wednesday 20th February 2013
Friday 22nd February 2013
15 per day - 35 three days
9 am to 5 pm

For more info contact:

01484 484134
james.hardy@thezone.uk.com
www.thezonehct.com
www.twitter.com/thezonehct

KIDS ZONE
GYM

14

APPLICATION FORM | CAPITAL LETTERS REQUIRED

Child Details
Day/s: 19th [ ] 20th [ ] 22nd [ ] Three days [ ]
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