Top Class Sport Booking Form.

NAME OF PARTICIPANT (in full):

Name of Parent(s)/Guardian(s):

CAMP/COURSE BOOKING 2012:

ADDRESS Line 1:

ADDRESS Line 2:

POSTCODE:

DAYTIME PHONE NUMBER:

E-MAIL:

Age:

Date of birth:

SCHOOL/CLUB:

School Year on September 2011:

Level of play this year:

Playing position (Lacrosse only):

Swimming ability - please comment:
(Applicable only to No Boundaries and Lacrosse Academy)

Resident/Non-Resident:

Medical (Please tick any boxes below that apply to your daughter’s medical condition):

Please use the box below to provide further details about any of the above conditions, as necessary:

Please confirm you have selected any medical conditions that your daughter has from the list above, by selecting "Yes" in this field box. No Yes

DIET:
(Please state any special dietary requirements)

Lacrosse T-shirt:
(Cost: £10 or free to participants on No Boundaries, Lacrosse Academy and Stick It camps)

Lacrosse Hooded Sweatshirt:
(Cost: £25 - add to final payment)

OTHER:
(Please use this box if there is any further information you would like us to be aware of - including room share, etc.)

PAYMENT METHOD:

AMOUNT:
(Total amount to include optional
T-Shirt - £10
and/or Hooded Sweatshirt - £25)