February Half Term Camp - 18th and 19th February 2019 (5 - 12 years)

This form is to be completed by the legal carer of the young person being enrolled in The Adam Virgo Academy Camp. It is a requirement that this form is completed and verified by the legal carer.

Legal carers are responsible for informing The Adam Virgo Academy Coordinator of any changes as they occur.  Please email info@adamvirgoacademy.com

All club sessions involving junior members are run under the guidance of coaches qualified to the appropriate level 1 - level 3 UEFA B and A qualification.

All information provided will be held under a secure SSL certificate purchased by the Academy. These details will be held in confidence. Our coaches need to know these details in order to meet the specific needs of your child.

 

Please note: All children are required to bring a packed lunch and plenty to drink. Please could they also wear correct footwear e.g. astro boots or molded football boots AND trainers in case of adverse weather conditions AND shin pads.

We ask kindly for all attendees to please respect the facilities and ask parents to park in the appropriate spaces provided by the venues.

Dates and Times

 

Online Registration Form

Price category
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Child's First name
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Child's Last name
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How would you (or your child) like to be addressed?
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Child's Age
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Child's Date of birth
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Child's Gender
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Parent/Guardian Full Name
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Relationship to Child
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Parent/Guardian Email
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Parent/Guardian Mobile
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Parent/Guardian Day Telephone Number
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Address 1
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Address 2
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City
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Postcode
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Country
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How did you hear about us?
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Name of School
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School Year
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Name of football club (if applicable)
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Favourite/current playing position
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Emergency Contact Name
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Emergency Mobile Number
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Does your child suffer from any medical conditions/allergies that the academy coach should be aware of (including any current medication) and any known health needs?
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Does your child take any medication?
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Any other special needs, learning difficulties, requirements, directions, that would be helpful for the coach to know about.
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Any additional information that will help the coaches?
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CONSENT (please read carefully)
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I will inform the coaches of any important changes to my child's health, medication or needs and also of any changes to our address or phone numbers given.
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In the event of illness, having parental responsibility for the above named child, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication.
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I agree to my son/daughter taking part in the activities of the club.
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I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those listed above, and accept his/her involvement in any activity the coaches put on, and permit my child to participate at their own risk.
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I understand that the Club or Organisers accept no responsibility for loss, damage or injury caused by or during attendance on any of the clubs organised activities except where such loss, damage or injury can be shown to result directly from the negligence of the Club or the Organisers.
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Please tick to confirm that you are happy to be contacted by the academy and continue receiving correspondence from the AV Academy via email, phone or SMS. * Please note all Data collected on the consent form will be held via a secure HTTPS connection which the academy has purchased.
Please confirm you have read and agree to the below Terms and Conditions
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Terms and Conditions
Promotional code
 
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Once you have received confirmation of membership, please book the relevant session.

Location

Contact Details

Contact us

For more information or to book please call:

or email: