Please fill in and return this form to the address below.

BSS Godalming, 2 Pewtrees Cottages, Lower Eashing, Godalming GU7 2QD

t: 01483 416002 e: c.darwen@icfds.com website: www.icfds.com/guildford

All children must be pre-booked before attending.

Your Child's Information Child 1 Child 2

Forename

Surname

Date of Birth
Emergency Contact Number:

Parent/Guardian Information

Parent/Guardian's Title: Mr/Mrs/Ms/Miss Forename Surname

Address

Postcode

Telephone numbers: Daytime Evening

E-mail address: How did you hear about the Brazilian Soccer School?

What most interested you about the Brazilian Soccer School?

Membership details
Venue: Broadwater School - £5 a session Membership Pack

Tuesday: 18:30 - 20:00 Core session 1 x Nike BSS Training Shirt

1 x BSS Guildford folder
Junior BSS
Tuesday: 17:30 - 18:15 Membership costs £25 and is compulsory
after 4 weeks

Sessions booking onto:

Preferred method of payment BSS Guildford Bank Details

Bank Transfer Natwest, Guildford High Street GU1 3AH
Cheque Sortcode: 60-09-21
Cash Acct: 74577239
Paypal Include ref: BSS (child's name & hours)
Paypal payments to c.darwen@icfds.com

(Please delete as necessary)

I DO/DO NOT give permission for any photo's to be taken of my child/ren during the course to be used for promotional/marketing material.

BOOKING TERMS AND CONDITIONS

I have read and understood this form, completed all the details requested to the best of my knowledge.
(1) All fees are payable in agreement with this form and are only refundable by credit - 30 days notice must be given before cancelling further payments
(2) All coaches are qualfied andhave had full C.R.B. checks completed. (3) BSS is not responsible for any loss or damage to personal belongings or effects.
(4) You agree to keep BSS training system confidential and to not directly or indirectly copy or use the BSS system; and you also agree to not directly or
indirectly manage or operate or assist in the organisation of any business which competes with BSS either while the child is a member of BSS
or for a period of three years afterwards.(5) I agree that only the child who is on the above form will be insured by BSS. Extra children attending will not be covered

Must be signed by parent/guardian before attending please.

Signed by Parent/Guardian Total Enclosed: £

Print Name: Date: