Juniors Beginners' Course Application Form 2010
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Surname
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Forename
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Gender
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male / female
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Date of Birth
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Address
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Post Code
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Any medical conditions of which we should be aware ?
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YES / NO (delete as applicable)
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If so, please give details
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Title & Name of Parent / Guardian
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Address (if different from above)
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Phone (day time)
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Phone (evening)
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E-mail
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How did you hear about us ?
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(…PTO…)
Payment
I enclose a cheque / postal order for £50.00 payable to Epsom Fencing Club.
Terms & Conditions
- 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.
- 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 both 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.
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