Child’s details:

Name: .............................................................................................................................................................. Age: .............................................. Date of birth: ........................................................................................... Male / female (please circle) Please inform us of any medical conditions, special requirements or allergies:

Medication can not be administered by UWE Centre for Sport staff or coaches

...........................................................................................................................................................................

Parent/Guardian details:

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

Contact numbers:

Work: ............................................ Home: .............................................. Mobile: .......................................... E-mail address: ................................................................................................................................................

Emergency contact details if different from above:

Name: ................................................................ Relationship to child: ........................................................

Contact numbers:

Work: ............................................ Home: .............................................. Mobile: ..........................................

Please make cheques payable to Matthew Honey for £55 If you wish to cancel it must be made by no later than 17th July to gain a full

to:

refund. After this date payments are

68 Josephine Avenue

non-refundable.

Lower Kingswood Surrey KT20 7AQ

Agreement of application:

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

Directions by road:

From M4:

exit the M4 at junction 19 onto the M32. Almost immediately, exit the M32 at junction 1. Turn right at roundabout onto the A4174 ringroad (dual carriageway) following signs for Filton and Bristol Parkway railway station. Past the Holiday Inn hotel on the left, turn left at the rst set of trafc lights into Cold-harbour Lane. Turn right at the roundabout into the Frenchay Campus.

From M5:

exit the M5 at junction 15 onto theM4 eastbound towards London. Exit the M4 at junction 19 onto the M32 and follow the directions from the M4 given above.

From the south:

from Bristol City Centre follow-signs for the M32. Exit M32 at-junction 1. Turn left onto the A4174, following signs for Filton and Bristol Parkway railway station. Go past the Holiday Inn hotel onthe left. Turn left at the rst set of trafc lights into Cold-harbour Lane. Turn right at the roundabout into the Frenchay Campus.

Contact details:

Centre for Sport, UWE Frenchay Campus Coldharbour Lane Frenchay, Bristol, BS16 1QY Telephone number: 0117 32 86200 E-mail: sport@uwe.ac.uk www.uwe.ac.uk/sport