Blackburn rovers may half term world cup soccer camp 2014 application form

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soccer camp

Blackburn Rovers Indoor Centre, Ewood Park, Saturday and Sunday**, Starts 1pm 4 to 11 year olds Optional food at Blues Bar*** One and a half hours of fun football coaching and games, a personal stadium tour of Ewood Park and a goody bag including one adult and one junior match ticket for the birthday boy or girl.

PRICES START FROM £9.75 PER DAY* or £39 for all 4 days

FREE party invites provided. To book or to reserve a Blackburn Rovers Football Birthday Party, call 01254 296256 or email faye.billington@brfctrust.co.uk

tuesday 27th to friday 30th may 2014. NEW TIMES - 8.30am - 5.00pm Fun football coaching and games, based on different World Cup countries, For boys and girls of all abilities aged 5-11. Pick and choose which days best suits you!

Fans of all teams welcome! Children who attend in a Rovers shirt or an international team’s shirt will be entered in to a special prized draw Book for the full 4 days and get 34 HOURS OF FUN* and a junior ticket for a Blackburn Rovers home match! To book or to reserve a place(s) call 01254 296256 or email faye.billington@brfctrust.co.uk or visit www.rovers.co.uk now. Places are limited to 80, available on a first-come, first served basis. *based on booking all 4 days at £39 (£39/4 days/8.5 hours per day).

* Maximum number of 15 children per party at £129. Additional children are £15 each. ** Non-matchday only. *** Additional cost for food. Price given on request. Blackburn Rovers Community Trust is a registered charity. Charity registration number: 1117122

@brfctrust

Blackburn Rovers Community Trust is a registered charity. Charity registration number: 1117122

APPLICATION FORM Payment Details: You can pay by card or cash. We no longer accept payment by cheque. To pay by card, complete this form indicating sessions to be attended and send with the relevant card details. To pay with cash please contact Faye Billington for further information on 01254 296256.

Name of Child: .........................................................................................................................................................................................................................

Address: ......................................................................................................................................................................................................................................... ............................................................................................................................................................. Postcode: ...................................................................

Name of Parent / Guardian:........................................................................................................................................................................................

Please tick the following soccer camp venue, which you would like your child(ren) to attend:

Mobile Number: .................................................................................. E-mail Address: .................................................................................

(BRFC may confirm your booking via email)

Blackburn - Blackburn Rovers Indoor Centre (BRIC), Ewood Park, BB2 4FJ

Male

Please tick the following boxes: (£12 per day, per child or £39 per child for all 4 days, saving £9!*).

If you book all 4 days it works out as little as £1.14p per hour! (£39/4 days/£9.75/8.5 hours per day).

(Cannot book per hour). Sibling discount available on request.

Female

D.O.B: ........................................................................................ Age: ......................................................................

I wish staff to be aware of any additional medical / behavioural condition(s) which my child has: (Please tick appropriately) Does your child have: Asthma - Yes

Epilepsy - Yes

No

No

Diabetes - Yes

No

Any other medical behavioural condition(s): All 4 days: (£39)

Or you can book individual days:

Tuesday 27th May: (£12)

Wednesday 28th May: (£12)

Is your child allergic to penicillin? Yes Thursday 29th May: (£12)

Friday 30th May: (£12)

Book all 4 days and get a junior match ticket for a Blackburn Rovers home game!

No refunds will be given under any circumstance.

Ethnic Origin: White British Black African

No

Bangladeshi

Black Caribbean

Indian

Black Other

Chinese

White Other

Pakistani Other

As parent / guardian I nominate the following person to act on my behalf in case of emergency if I am unavailable: Relationship to child: ................................................................. Contact details: ..........................................................................................

Where did you find out about the Soccer Camp: ....................................................................................................................................

Number of days: ................................. Total Amount to pay: £ ......................................................................... Credit Card

Child’s School (including town): ...........................................................................................................................................................................

Card Number: ............................................................................................... Start Date: ......................... Expiry Date: .............................

(Please tick as appropriate)

Security Number (CVC): .............................................Issue No: ...........................

I give consent for BRCT staff to take the required action should my child need emergency medical attention and to administer general First Aid for minor injuries

Participants should bring their own packed lunch, drinks, warm clothing and appropriate football attire. Training to take place on astroturf. No studs or blades.

I consent to my child’s photo, which may be taken during a session, being stored and used in promotional material produced by Blackburn Rovers Community Trust/Blackburn Rovers Football Club/Football League Trust. Please tick here if you object:

Code of Conduct: The following codes of conduct are in place to ensure that all participants get the best possible experience: Everyone must: · · · · ·

Wear appropriate sports clothing & footwear - trainers (no blades allowed) Follow the instructions & guidance of staff at all times Report accidents and incidents immediately Not use offensive language, be aggressive, racist or bully others Not refuse to do any activity without permission from a member of staff

Anybody who fails to follow the codes of conduct will be at risk of forfeiting their place without refund.

Name of Parent / Guardian completing this form: ..............................................................................................................................

Signature: ........................................................................................................ Date: ...........................................................................................................

Limited places available on all activities. Applications will be treated on a first come first served basis.

All staff are DBS checked and coaches have FA and national governing body qualifications. The Trust reserves the right to cancel any activity and/or change part of the sessions/activities. In such exceptional cases advance notice will be given before the due start of the session and full refund will be made to those due to participate. *compared to booking individual days.

I consent to the information given above being held electronically in order that my child may be kept informed of further Blackburn Rovers Community Trust/Blackburn Rovers Football Club /Football League Trust opportunities which maybe of interest. Please tick here if you object: I consent to my child, who is aged 8 years and over, leaving the premises unaccompanied at the end of the session: Please note - In accordance with safeguarding policy any child aged 8 or under must be collected by his/her parent/guardian or named adult from inside the Trust premises at the end of the session.

(For BRIC Soccer camp only) I give consent for my child to use a computer and the internet under the supervision of BRFC staff on a lunch break. (Internet access is restricted to education based games and football websites. All social media sites are not accessible).

Please tick here if you do not wish to be added to our mailing list: Please return the completed application form to: Blackburn Rovers May Half-Term Soccer Camp, Blackburn Rovers Community Trust, Ewood Park, Blackburn, BB2 4JF. If your method of payment is by paying cash, please call Faye Billington on 01254 296256, between the hours of 9am-5pm, Monday to Friday.

Blackburn Rovers Community Trust is a registered charity. Charity registration number: 1117122