Autumn Term TimeKids Courses

APPLICATION FORM

Sports DevelopmentFort Regent, St Helier JE2 4UX

Telephone +44 (0)1534 449617Fax +44 (0)1534 449825Email sport@gov.je

Education, Sport and CultureFor further information please email sport@gov.je or visit www.gov.je/sport

Find us on facebook at www.facebook.com/SportsDevelopmentJersey

Tweet us @jerseysport

CASUAL SESSIONS

Courses

For 7 – 9 year olds at Fort Regent with David TRAMPOLINING £37.50 for the 10 week course / 3.45pm – 4.45pm

2467 Wednesday 11 September – Wednesday 20 November (no class 30 October)

For 10 year olds and over at Fort Regent with David TRAMPOLINING £37.50 for the 10 week course / 4.45pm – 5.45pm

2468 Wednesday 11 September – Wednesday 20 November (no class 30 October)

For 5 & 6 year olds at Springfield with Martin FOOTBALL £45.00 for the 12 week course / 3.45pm – 4.30pm

2469 Wednesday 11 September – Wednesday 4 December (no class 30 October)

2470 Friday 13 September – Friday 6 December (no class 1 November)

For 7 year olds and over at Springfield with Martin FOOTBALL £45.00 for the 12 week course / 4.30pm – 5.15pm

2471 Wednesday 11 September – Wednesday 4 December (no class 30 October)

2472 Friday 13 September – Friday 6 December (no class 1 November)

For 8 - 14 year olds at Grainville School (Dance Studio) with Gianpaolo FENCING £45.00 for the 12 week course / 6pm – 7pm

2524 Monday 9 September – Monday 2 December (no class 28 October)

For school years 3 & 4 at Oakfield Sports Centre CRICKET £37.50 for the 10 week course / 6pm – 7pm

2522 Wednesday 2 October – Wednesday 11 December (no class 30 October)

For school years 5 & 6 at Oakfield Sports Centre CRICKET £37.50 for the 10 week course / 7pm – 8pm

2523 Wednesday 2 October – Wednesday 11 December (no class 30 October)

For 7 – 15 year olds at Fort Regent (Queens Hall) FUN ACTIVITIES £2.30 per session – pay at reception

Every Tuesday and Thursday from 4.30pm to 5.30pm

for 12 – 15 year olds at Les Quennevais Sports Centre with Sue SPINNING £3.75 per session or free to active card holders – pay at reception

Every Monday and Thursday from 4.45pm – 5.30pm.

Autumn Term TimeKids Courses

APPLICATION FORM

Please return to: Sports Development, Fort Regent, St. Helier, Jersey, JE2 4UXData Protection Law (Jersey) 2005 The information provided by you on this form is required by the Sport & Leisure Division for the purpose of course enrolment and coaching requirements. Children’s information supplied by you may be disclosed to sports coaches. Financial details provided will be securely disposed of at the end of each course.

Child’s Name: Date of Birth:

Home Address:

Post Code:

Tel. Day: Tel. Eve:

Emergency Contact Name & Tel. Number:

Email: School Attended:

Please list allergies and statement of special needs, etc.):

I consent to my son/daughter’s participation. I undertake to see that my son/daughter is provided with the required clothing/equipment where appropriate. I permit my son/daughter to be transported in departmental minibuses. To the best of my knowledge, my son/daughter is medically fit to participate in the activities involved and I undertake to inform you in advance of any alteration to this position. I consent to my son/daughter being given emergency medical treatment.

Please notify us in writing if your son/daughter is being collected from an activity by another adult or if your son/daughter is able to make their own way home. All courses have limited availability and are offered on a first come, first served basis. Early booking is advised. Sports Development reserves the right to cancel or amalgamate classes where necessary. Please note that requests for refunds must be made in writing to Sports Development at least one week before the course start date. Please list your course requests below. We are unable to process refunds under the value of £7.

Course Code Activity Description Amount

Method of payment: Cheques should be made payable to “Treasurer of the States”.Or Credit/Debit card number

Valid From / Expiry Date / Issue No.

Name of Cardholder

Cardholder’s Signature

Parent’s Signature: Date: