Saturday Sports Club application form

Please print out and complete this form, and send it to:

Mr. D. J. Whistance
Kilderkin
The Old Malthouse
Nottington
Weymouth
Dorset DT3 4BH

Please enrol___________________________
D.O.B.:___/___/___ Age:_____
Home address:______________________
___________________________________
___________________________________
Post Code:_________ Phone:(______) ___________
E-mail:___________________________
Attending School:________________________ in year:_______
Medical Problems:_____________________________
I enclose a cheque made payable to The Saturday Sports Club or cash to the value of �34 for the eight week Sports Course 19th May - (SUNDAY) 8th July 2001, 1:00p.m.-4:00p.m. at Westhaven County Junior School, Radipole Lane, Weymouth, Dorset.
Family Prices:
�60 for two children(__) Please tick if this applies
�75 for three children(__)
Signed:______________________________(Parent/Guardian)
Signed:______________________________(Young Person)
Parent/Guardian please print name:_______________________________
Acknowledgement and receipt will be sent by return of post.

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