Football For All Online Booking Form

Full Name
Age
Email address
Emergency Contact Number(s)
Address
Any relevant health problems or disabilities
“Be a Team Player” discounts*
Player 1 (5% off) Phone number
Player 2 (10% off) Phone number
Player 3 (15% off) Phone number
*See website or brochure for details
Name of Course
Course Number
Days Attending
Money enclosed
Cheques should be made payable to Football For All. Please ensure that the name of your child, home address, course venue & cheque guarantee card number are written on the reverse of the cheque.	Please send the completed form, together with your remittance to: Football For All 76 Ardleigh Court Hutton Road Brentwood Essex CM15 8NA
Parental Consent I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organisers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course,	other than that imposed by law. I give consent to photographs of my child being reproduced for use by the organisers. I have read and accepted the above conditions and confirm that I am legally entitled to give this consent.
Signature of parent/carer
Name of parent/carer