Epsom Fencing Club

Print   Close Window

Juniors Beginners' Course Application Form 2017

Surname

:

………………………………………………………………………………

Forename

:

………………………………………………………………………………

Gender

:

male / female

Date of Birth

:

………………………………………………………………………………

Address

:

………………………………………………………………………………

 

………………………………………………………………………………

Post Code

:

………………………………………………………………………………

Any medical conditions of which we should be aware ?

:

YES / NO (delete as applicable)

If so, please give details

:

………………………………………………………………………………

Title & Name of Parent / Guardian

:

………………………………………………………………………………

Address (if different from above)

:

………………………………………………………………………………

 

………………………………………………………………………………

Phone (day time)

:

………………………………………………………………………………

Phone (evening)

:

………………………………………………………………………………

E-mail

:

………………………………………………………………………………

How did you hear about us ?

:

………………………………………………………………………………

Payment

Delete as applicable (bank transfer preferred):

  • I shall submit payment by bank transfer (e-mail us via http://www.epsomfencingclub.org/contact for bank details)
  • I enclose a cheque / postal order for 80.00 payable to Epsom Fencing Club

Terms & Conditions

  1. This fencing course is for juniors aged from 10 to 13 years old
  2. Neither Epsom Fencing Club, its coaches, instructors nor members shall, in any circumstances whatsoever, be under any liability to the applicant for any loss, damage or injury (including death), whether accidental or otherwise, arising during, or resulting from participation in fencing activities within the Epsom Fencing Club premises or on the Club's behalf.
  3. Payment of any subscription or course enrolment fee to Epsom Fencing Club shall constitute an acceptance of all articles of its Constitution, a copy of which is obtainable from the Secretary.

Data Protection

Personal details of applicants are not disclosed to any third party.

Declaration / Consent (to be signed by Parent / Guardian)

I have read and understood the above information and agree to abide by the Constitution and Rules of Epsom Fencing Club.

 

Signature ……………………………………. Date …………………..

 

Please complete all pages of this enrolment application form and submit it with your payment (payable to Epsom Fencing Club) to:

Mr Nick Payne
65 Stamford Green Road
Epsom Surrey
KT18 7SR

Applications will be accepted in strict order of receipt of the form with payment.

Back to Top   Print   Close Window