A5 Leaflet FRONT
n e e w o l l Ha Camp 2014
APPLICATION FORM Name ......................................................................................................................... Address ............................................................................................................................................................................ Postcode.......................................................................................................................................................................... Telephone No: Date of birth: Camp(s) attending:
(Please Tick) DETAILS ON REVERSE
CAMP 1 - Ards Leisure Centre
❑
CAMP 2 - Lisburn Racquets Club
❑
£15 per person
Emergency Contact Name........................................................................................................................................... Emergency Contact Number ........................................................................................................................................ Email .................................................................................................................................................................................
www.netballni.org
Win
Camps will include netball skills, drills and match play as well as playing netball you will have the chance to learn more about the game, meet an NI Squad player and enter our competition...
a weeke nd famil y pass to the N etball Eu rope Op Champio en nships in NI 2015
Camp 1 OPEN TO P6, P7 & YEAR 8 PUPILS Monday 27th & Tuesday 28th October 9.15am - 12.15pm Ards Leisure Centre in conjunction with Phoenix Netball Club £15 PER PERSON
Camp 2 OPEN TO P6, P7 & YEAR 8 PUPILS Wednesday 29th & Thursday 30th October 9.30am - 12.30pm Lisburn Racquets Club £15 PER PERSON
Please complete this registration form and return with payment to; Karen Rollo Club & Coach Development Officer Netball Northern Ireland Lisburn Racquets Club 36 Belfast Road Lisburn BT27 4AS
PAYMENT: Please ensure you enclose payment with the registration form as booking cannot be confirmed without payment. Please make cheques payable to Netball NI. Alternatively you can pay us via BACS using the following details. (Please state your daughter’s name as the payment reference) BANK: First Trust Bank ACCOUNT NO: 01369022 SORT CODE: 93 86 23
Are you attached to a local netball club? Yes
❑
No
❑
Medical conditions (eg. epilepsy, asthma etc.) Do you consider yourself to have a disability? Yes the nature of your disability... Visual ❑ Learning Hearing ❑ Multiple ❑ Physical Please advise us if you require learning support whilst attending the camp)
❑
Other
❑ No ❑ If Yes, what is ❑ Rather not say
In accordance with the monitoring regulations 1994 please indicate the community to which you belong by ticking the box below;
❑ ❑
I am a member of the Protestant Community
❑
I am a member of the Roman Catholic Community
I am a member of neither the Protestant or Roman Catholic Community
I am willing to let my child participate in any official media including television, photography, print & social media.... Yes
❑
No
❑
I am responsible for making arrangements for getting my child to and from the venue (into the sports hall, not
the car park) and I understand that Netball NI personnel are not responsible for her once she leaves this point Yes
❑.
APPLICATION FORM Name ......................................................................................................................... Address ............................................................................................................................................................................ Postcode.......................................................................................................................................................................... Telephone No: Date of birth: Camp(s) attending:
(Please Tick) DETAILS ON REVERSE
CAMP 1 - Ards Leisure Centre
❑
CAMP 2 - Lisburn Racquets Club
❑
£15 per person
Emergency Contact Name........................................................................................................................................... Emergency Contact Number ........................................................................................................................................ Email .................................................................................................................................................................................
www.netballni.org
Win
Camps will include netball skills, drills and match play as well as playing netball you will have the chance to learn more about the game, meet an NI Squad player and enter our competition...
a weeke nd famil y pass to the N etball Eu rope Op Champio en nships in NI 2015
Camp 1 OPEN TO P6, P7 & YEAR 8 PUPILS Monday 27th & Tuesday 28th October 9.15am - 12.15pm Ards Leisure Centre in conjunction with Phoenix Netball Club £15 PER PERSON
Camp 2 OPEN TO P6, P7 & YEAR 8 PUPILS Wednesday 29th & Thursday 30th October 9.30am - 12.30pm Lisburn Racquets Club £15 PER PERSON
Please complete this registration form and return with payment to; Karen Rollo Club & Coach Development Officer Netball Northern Ireland Lisburn Racquets Club 36 Belfast Road Lisburn BT27 4AS
PAYMENT: Please ensure you enclose payment with the registration form as booking cannot be confirmed without payment. Please make cheques payable to Netball NI. Alternatively you can pay us via BACS using the following details. (Please state your daughter’s name as the payment reference) BANK: First Trust Bank ACCOUNT NO: 01369022 SORT CODE: 93 86 23
Are you attached to a local netball club? Yes
❑
No
❑
Medical conditions (eg. epilepsy, asthma etc.) Do you consider yourself to have a disability? Yes the nature of your disability... Visual ❑ Learning Hearing ❑ Multiple ❑ Physical Please advise us if you require learning support whilst attending the camp)
❑
Other
❑ No ❑ If Yes, what is ❑ Rather not say
In accordance with the monitoring regulations 1994 please indicate the community to which you belong by ticking the box below;
❑ ❑
I am a member of the Protestant Community
❑
I am a member of the Roman Catholic Community
I am a member of neither the Protestant or Roman Catholic Community
I am willing to let my child participate in any official media including television, photography, print & social media.... Yes
❑
No
❑
I am responsible for making arrangements for getting my child to and from the venue (into the sports hall, not
the car park) and I understand that Netball NI personnel are not responsible for her once she leaves this point Yes
❑.
