Applicant DetailsFencers DetailsFinancialMedicalConsents Applicant Details Details of person registering the entry (Parent, carer, Club or Team manager) First Name* Name of person completing this form Family Name* Name of person completing this form Address* Your address Town or London Borough* City, Town or London Borough County* London Essex Hertfordshire Kent Surrey other London means one of the 32 London boroughs Post Code* Please use upper case. At least one space! Email* Must be that of a person 16 yrs or over. We will use this to send you urgent information and future events you may be interested in Repeat Email* (It's amazing how often this is different!) Main Contact number* Must be that of a person 16 yrs or over. (You must have a space in the number!). We will only contact you if absolutely necessary Prove you are human !* What is 2 x 8? SubmitNext Fencers Details First Name of fencer* Name of the person attending the course Family Name Date of Birth* Club(s) The Club(s) the fencer normally fences at Coach(es) Present coach(es) About You Number of years fencing and level of competitions entered SubmitNext Financial Payment Details Days* Mon Tue Thu Fri 1 day £67, 2 days £134, 3 days £201, 4 days £241 (10% discount) SubmitNext Medical Please advise any issues that may affect the fencer and might become apparent while fencing. eg Diabetes, asthma, epilepsy, epipen user, heart condition, etc., we really need to know! Knowing about learning or behavioural issues helps us understand and integrate a child but providing this is entirely voluntary. All information will be kept confidential and only shared with the Coaches, Club Officers and the emergency services Medical Status None Visual Impairment Hearing Impairment Physical Disability Learning Behavioural Multiple other: Anything we should be aware of eg the nature of the disability Do you consider you/your child to have a disability?* Yes No Defined by the Disability Discrimination Act 1995: "A physical or mental long term impairment which has substantial long term adverse effect on ability to carry out normal day to day activities" Emergency Contact* Name of Emergency Contact (parent, carer, doctor, friend, specialist, etc.) Emergency Number* For the Emergency contact (Leave a space in the number) SubmitNext Consents I accept that the organisers, officials, sponsors and the University of East London cannot be held responsible for any accident, loss or damage sustained at the venue. Further, I agree that on site first aiders have permission to act 'in loco parentis' to administer emergency first aid or other medical treatment Confirm Conditions* How did you hear about the event? Newham Swords Club email Email from London Region Your own club Newham Swords Facebook page LP Fencing Forum Facebook Competitions page A friend Entered previous event other: Thank you! Payment Method* GoCardLess Paypal CR/DR Card Cheque Please Indicate how you intend to pay. Payment email address* Please enter the email address you will use for electronic payment. This is essential to match payment to applicant. If paying by cheque use the email you used earlier. Payment emails are not retained. SubmitNext
