APPLICATION FORM

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Haringey Sports Development Trust, White Hart Lane Community Sports Centre, London N22 5QW

PROGRAMME DATES FOR 2014
EASTER Mon 7th Apr - Fri 11th Apr [10am-3pm]
Child's name
Date of birth
Address
School
Telephone
Emergency Telephone No
Understand: It is understood that Haringey Sports Development will not be liable for any loss or injury which the above applicant may sustain whilst attending any athletic development course. Should there be any information concerning your child's medical history which you feel we should know (eg inhalers etc), would you please give brief details below:
If you wish for your child to go home by themselves please tick box to give permission 
If you do not wish your child to be photographed please tick 

Whizz Kids Cost: £30 per week. Families with more than one child attending £30 for the first child and £28 per child thereafter.

Cancellations: Refunds will only be made in medical circumstances.
"Fee enclosed Cheque  Cash 
"Fee enclosed Cheque  Cash 
"Fee enclosed Cheque  Cash 
Parent's Signature
Parent's Name (Print)
AWARDS: All youngsters will receive a special designed Medal; Participation Certificate
LATE PICK-UPS: Whizz Kids finished at 3pm. As we have had some late pick ups in the past we are going to start charging anyone who turns up later than 3.30pm. We will charge £5 per half hour. Please could you pick up your child on time.


Office use only:

Reg. no:

 Rec. no: Auth.