Linden Grove, Coxhoe, Durham, DH6 4DW Tel: 0191 301 8302 info@activelifecoxhoe.co.

uk

For ages 4-11 2-13 April, 2012

MULTI SPORTS
Wednesday 4 April & Wednesday 11 April 10:00am-3:00pm 8 per day.
Keeping children of any ability fit and active during the Easter break with lots of fun coached sports and games. Children will need a packed lunch/plenty of drinks and suitable clothing and footwear.
To register your child simply fill in this form and return with payment to the Active Life Centre @Coxhoe at the address above. Payment can be in form of cash, cheque, or credit/debit card. Please make cheques payable to Future Leisure in Coxhoe If you have any questions about the Multisports session you can contact Craigs Coaching on 07525492385 or email craigscoaching@yahoo.co,uk

CRAIGS COACHING APPLICATION FORM Name_________________________________________________ Age____________ Contact Home No___________________________________________ Mobile No_________________________________________________ Address___________________________________________________ ___________________________________________ Postcode__________________ E-mail____________________________________________________ Dates To Attend please tick

4th

11th

MEDICAL CONSENT FORM

Medical conditions

Details of any current medication: We the undersigned, in consideration of our childs participation in the Craigs Coaching program at Active Life Centre @Coxhoe and the information supplied on the application form we agree to the following: My child is in good health and I consider them capable of taking part in the multisport programme. I have completed the application form where I have listed any medical conditions and details of any medication taken whilst my child is on the Craigs Coaching programme at Active Life Centre @Coxhoe. In the event of illness or accident, I consent to any 1st aid treatment necessary given to my child whilst on the Craigs Coaching programme at Active Life Centre @Coxhoe. Please note that Craigs Coaching or Future Leisure in Coxhoe cannot be liable for any personal loss or injury that any child sustains whilst on the programme and it is parents/guardians responsibility to inform Craigs Coaching and Active Life Centre @Coxhoe of any medical conditions that could affect their childs participation.

Photograph Authorisation
Active Life @Coxhoe occasionally may wish to use photographs of the childrens and youth programme sessions we run. These photographs are generally used for promotional purposes, or as evidence of work that is being done with children and young people. I understand that if any young person is identified, only their first name will be used If you consent for your childs photograph to be used for these purposes, please complete the form below and return to the Active Life Centre @Coxhoe. I hereby agree that Active Life @Coxhoe has my permission to use any photograph(s) of my child for the uses stated above and not for any other purpose unless I am informed, and in agreement. It is my understanding that if my child is identified in a publication or website, only their first name will be used. Parent/Guardians Name: Signature Date

PLEASE NOTE YOU WILL RECEIVE NO CONFIRMATION. ACTIVE LIFE CENTRE @COXHOE WILL NOTIFY YOU IF COURSE IS NOT TO GO AHEAD.
Active Life @Coxhoe is managed by Future Leisure in Coxhoe (FLiC) Registered Charity No. 1145037