Application Form

SOCCER CHAMPS

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Application Form

Please complete the form, print and send it to:

Soccer Champs

18 Phoebes Orchard

Stoke Hammond

Bucks

MK17 9LW

We will contact you to confirm your childs place as soon as we receive the completed form and payment.

Contact information:

Childs first name:

Childs surname:

Childs D.O.B:

Childs school:

Parent / Gaurdian:

E-Mail:

Address:

Home no:

Mobile no:

Work no:

Emergency no:

Medical Information:

Doctors tel no:

Doctors Name & Address:

My son / daughter wishes to attend the following Soccer Champs camps:

I enclose payment in

for £:

Dates:

Sibling:

Siblings name:

Do you consent to your childs

photo being reproduced for

Soccer Champs marketing

& promotional purposes?

Do you wish to receive further mailings:

I hereby accept that Soccer Champs, their coaches and the premises they use, are in no way liable for any personal injuries and or loss or theft of any personal items whilst my child is attending the camps.

Parent / Gaurdian Signature:

Soccer Champs - Miles & Kelly Emmett

18 Phoebes Orchard

Stoke Hammond

Bucks

01525 270090 / 07590 011559 / 07971 858878

miles@soccerchamps.co.uk