Epsom Fencing Club

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Junior Beginners Fencing Course Application Form 2018

Surname  
 
Forename  
 
Gender  
 
Date of Birth  
 
Address  
   
 
Post Code  
 
School
(optional)
 
 
Are there any medical conditions of which we should be aware ?
If so, please give details.
 
   
 
Title & Name of
Parent / Guardian
 
 
Address (if different from above)  
   
 
Phone (mobile)  
 
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. Temporary membership of Epsom Fencing Club will be conferred on those enrolled on any course organised by Epsom Fencing Club.
  3. 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.
  4. Payment of any subscription or course enrollment 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 enrollment 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.

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