Term Time Coursesfor sprightly KidsGet your lively little ones out and burning off some of that excess energy while you take a break! Children's Term Time Courses are now taking place in Education, Sport and Culture Sports Centres across the island!

Education, Sport and CultureSports DevelopmentFort Regent Sports CentreSt HelierJersey JE2 4UXTel +44 (0)1534 449617Fax +44 (0)1534 449825

Course Application FormChild’s Name: Date of Birth:

Home Address:

Post Code:

Tel. Day: Tel. Eve:

Emergency Contact Name and Tel. Number:

Parents Place of Work and Contact Number:

Please list recent vaccinations and Health Record (inc. any allergies, 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 been given emergency medical treatment.

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 (over £7) must be made in writing to the Sports Development Officer at least one week before the course date. Please list your course requests below:

Cheques should be made payable to “Treasurer of the States”, please write child’s name on the reverse. Alternatively you may pay by Credit/Debit Card:

Course Code Activity Description Amount

Name of Cardholder:

Cardholder’s Signature:

Parent’s Signature: Date:

Please return to: Sports Development, Fort Regent, St.Helier, Jersey JE2 4UX

Valid from: / Expiry Date: / Issue No.CVV: