Supported byAntrim Hockey ClubSummer Camp

2015

The Summer Camp is a fantastic opportunity to hone your skills and enjoy a great five days playing hockey and having fun!

Open to boys and girls of any skill level (beginner or experienced) who are between the ages of 8 and 13 years of age!

It is hugely popular so apply now to ensure you get your place.

Dates: Monday 17th to Friday 21st AugustTime: 10am – 12 noonVenue: Antrim Forum Hockey Pitch (Paddy Marks Arena)Cost: £25 per child (£20 each for siblings)

Please complete the application form and return it to:AHC Summer Camp, 31 Ashcroft Way, Ballinderry Lower, Lisburn, BT28 2AY, N. Ireland.

Applications are also available… On Our Facebook Page: Antrim Hockey Club On Our Website: www.antrimhockeyclub.com

For more information contact:

Tommy Monahan078 2877 2037

www.facebook.com/antrimhcni

tommymonahan39@yahoo.co.uk

Application FormPlease complete one application and consent form per child. All information on this form will be treated in strict confidence.

Child’s Details Parent/Guardian DetailsForename ___________________ Forename ___________________Surname ___________________ Surname ___________________Gender ___________________ Address ___________________Date of Birth _ _ - _ _ - 20_ _ (DD-MM-YYYY) _______________________________________Age ___________________ Postcode ___________________ Child must be between 8 and 13 years of age. Daytime Phone ___________________

Mobile Number ___________________Named person(s) to collect child (must be 18+) Alternative contact (in the case you cannot be_______________________________________ contacted in the case of an emergency)_______________________________________ ___________________ ___________________

I agree that my child may make his/her own way home afterwards (tick if applicable)----------------------------------------------------------------------------------------------------------------------------------------------Please read the following information carefully and sign in the space provided to show you understand and accept the statements. We cannot accept an application without this.MEDICAL DETAILSPlease note medicines cannot be administered by staff members. If your child has a severe enough condition that he/she could be affected by physical activity, please enclose a letter from your doctor giving consent for your child to take part. Please give details of any relevant medical history including allergies (if needed please continue on a separate sheet).______________________________________________________________________________________________________________________________________________________________________________PHOTOGRAPHY AGREEMENTAt points during the camp, photographs may be taken of the children to use on promotional materials. If you do not wish for your child’s photo to be taken, please tick the box below.

Tick if applicable.

PARENT DECLARATIONIn the event of an accident, I hereby give my consent for a trained member of staff to administer first aid. In the event of any emergency, if the alternative contact or I cannot be reached, I hereby give consent for my child to be transported to hospital and/or be given any medical, surgical or dental treatment, including general anaesthetic, as considered necessary by the medical authorities present.I fully understand if my child is not between 8 and 13 years of age or if their behaviour is unacceptable to Antrim Hockey Club, they can be removed without refund. On signing this form I agree to all statements, terms and conditions within it and wish my child to attend the specified camp, enclosing £25 in cash or £25 in cheque made payable to Antrim Hockey Club (or £20 each in the case of siblings, details above). Places are limited, therefore early registration is recommended to avoid disappointment. If you would like to discuss any of the points on this form, please contact Antrim Hockey Club (contact details are on page 1 of the form). Antrim Hockey Club also reserves the right to cancel or modify the camp at any time.

PRINTED NAME SIGNATURE______________________________________ ________________________________________