Players that are aged 18 or over: Please complete all elements of the form

Players that are under 18: This form MUST be completed by the adult with legal parental responsibility for the young person i.e. parent/ carer/ guardian.

Players full name: ……………………………………………………………………………………………………………………………………….

Age: ......

Date of Birth:……......

If under 18, Parental Name:……………………………………………………………………………………………………………………….

Address:…………......

…………………......

Tel (If under 18 please provide a parental contact telephone number)......

Email (If under 18 please provide a parental email)...... ……………………………………………………………………..

Dietary requirement’s:……………………………………………………………………………………………………………………………….

Medical Conditions: (give details of allergies/disabilities):………………………………………………………………………….

…………………......

State Disability:……………………………………………………………………………………………………………………………………......

Classification:………………………………………………………..

Current Club:………………………………………………………......

S / M / L / XL

Vest/T-shirt size (adult size)

  1. Only completed booking form with payment in full will be accepted. Payments are non-refundable.
  1. We reserve the right to:

i) Reject applications incorrectly completed or at our discretion

ii) Change the programme as necessary without prior notice In the event of unforeseen circumstances (venue, weather, staff, equipment or other)

iii) Exclude participants from activities or the whole camp in the event of unacceptable behaviour

iv) Use all photographic & video material for promotional purposes.

  1. We have Public Liability insurance to cover all participants subject to the terms & conditions herein or as may be subsequently advised prior to the Camp.
  1. In the event of minor injuries or illness, we will provide first aid or medical assistance or refer to higher medical services where we are unable to treat participants. All participants must be sufficiently equipped with all medications for the duration of the camp.
  1. Parents/Guardians must supply details of the participants medical, special & dietary needs prior to the camp. Notwithstanding this, all participants must undertake all daily living activities independently.
  1. Check in will be9am on 15th August & check out by 9.30am on 17thAugust 2015.
  1. We will not be responsible for loss or damage to any equipment or personal effects belonging to the participants.
  1. Accommodation is provided in the dormitories & participants will be responsible for any loss or damage caused as a result of inappropriate behaviour or use of equipment & services.
  1. The Centre staff will supervise the accommodation at intervals overnight.
  1. Smoking & the consumption of alcohol is strictly forbidden & anyone not complying with this rule will be discharged from the camp with immediate effect.
  1. Cheques Payable to British Wheelchair Basketball (BWB).
  1. All Bookings are confirmed in writing.

I have read and hereby accept the booking terms and conditions.

Signature of athlete / or parent/guardian if under 18: …………………..…………………………………………………….

Date of camp: Saturday 15th– Monday 17th August 2015

Location of camp:University of Worcester

Camp Organiser:Franky Harper –

Players that are aged 18 or over: Please complete all elements of the form

Players that are under 18: This form MUST be completed by the adult with legal parental responsibility for the young person i.e. parent/ carer/ guardian.

Name of young person:......

Date of Birth:......

Address: .…......

…………………......

Emergency Contact Name:......

Emergency Contact Telephone Number:......

Relationship to young person:......

Medical Conditions (give details of allergies/disabilities):..……......

…………………......

Doctors name: ………………………………………………………………………………………………………………………………………….

Address: …………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………………

Telephone: …………………………………………………………………………………………………………………………………………………

Does your child have any additional needs that you feel we should be aware of? Please note this information is only shared with the camp Head Coach

…………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………

  1. I consent to(insert name)…………………………………………………...... attending the summer camp,15th – 17thAugust 2015 at University of Worcester, and being given any necessary medical treatment as required.
  2. I understand that young people attending the campare NOT insured against loss/theft of or damage to property. I understand that any personal travel insurance must be arranged by me.
  3. I understand that young people attending are insured against personal injury from when they sign in until signing out of the camp.
  4. My child is in good health and I consider him/her capable of taking part in thecamp. I have completed the medical details above and understand that every effort will be made to obtain personal consent but that in an emergency, prompt action may be required. Therefore any necessary treatment which a medical practitioner deems necessary can be administered to my child, which may include the use of anaesthetics. If my child is taking regular medication I will ensure he/she carries enough medication for the duration of the camp.
  5. Any musculo-skeletal injuries sustained during the camp will be initially seen by the camp physiotherapist.
  6. I agree that my child will abide by any safety requirements and consent to my child taking part.

During the summer camp, photographs and videos may be taken of all participants by, or on behalf of, British Wheelchair Basketball. I hereby grant British Wheelchair Basketball the right to use the film and or photograph(s) resulting from the film shoot, and any reproductions or adaptations of the film and or photograph(s) for all general purposes in relation to British Wheelchair Basketball work including, without limitation, the right to use them in any publicity materials, websites, books, newspapers and magazine articles whenever British Wheelchair Basketball chooses to do so. Unless you notify the Camp Head Coachwe will assume that you will agree to this.

Please tick this box to confirm you have read and agree with the statements above and consent to your child’s involvement in the selection campand sign below.

Signature: ......

Name in Full: ......

Please delete as appropriate: Parent/Guardian/Carer/Other/Please state: ......

......

Date: ......

Please complete & return this form by Monday 6th July to:Franky Harper:

British Wheelchair Basketball, SportPark, 3 Oakwood Drive, Loughborough, LE11 3QF