OCTOBER HALF TERM
SPORT PROGRAMME
@
Lilian Baylis Old School,
Monday 27th ~ Friday 31st October
Children aged 8 - 16 years old
10.00am ~ 4.00pm
For more info please call
020 3268 0012 / 020 78203444
Football, Basketball, Street Dance, Boxing, Tennis and much more!
Registration Form
Lilian Baylis Old school,
T: 0203 268 0012 F: 0203 242 0004
Parental Consent Form
I consent to my child attending the October Half Term programme delivered by Sport Action Zone, and funded by the Positive Futures at Lilian Baylis Old School from 27th – 31st October 2008, 10 - 4pm
All children must bring appropriate sports wear Astroturf/Trainers, Shin Pads, drink, and Pack Lunch
Parents/Carers must complete this form and hand it in person to the Sport Action Zone staff.
Name: ………………………… Surname: ……………………………………………
Address: ……………………………………………………………………………………………..
………………………………………………… Postcode:………………………………………………..
Telephone: ………………………………Mail:…………………………
Date of birth: ………………………………Œ Male Œ Female
School attended: ………………………………Year Group: …………………………………………….
Emergency Contact Name:…………………………………Contact Telephone:…………
Relationship to participant: ……………………………………………………………………………
Please state any achievement,education/sport/music/art: ……………………………………………
Please state which Housing Association/ Council you live at: ΠFamily Mosaic ΠHyde Southbank Homes
Œ
Medical:
Please give details of any medical conditions, disabilities or allergies, including any current medication:
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
If your child requires medical attention/medicine during the programme, do you consent for a member of staff to provide this? ΠYes ΠNo
Ethnicity: Religion: …………………………………
a) White
ΠBritish ΠIrish ΠOther White background
b) Mixed
ΠWhite and Asian ΠWhite and black
ΠWhite and black African ΠOther mixed background
c) Asian or Asian British
ΠIndian ΠPakistani Bangladeshi ΠOther Asian Background
d) Black or Black British
ΠCaribbean ΠAfrican ΠOther Black background
e) Chinese or other ethnic group
Œ Chinese Œ Other ethnic group …………………………………
How did you hear about activity?
ΠSchool ΠFamily/Friend ΠYouth worker/group ΠAdvertisement ΠAttended Previously
Œ Other, please specify ……………………………………………….
Use of photographs/video material
Occasionally the external partner’s who have funded the programme will take photographs or video material to be used for promotional/funding purposes only. If you do not consent to have yourself/your child feature in these please tick here Œ
Consent
As parent/guardian of ……………………………………I agree to my child participating in the activities as part of this programme. I have informed SAZ of any medical conditions from which my child suffers that may be relevant. I am responsible for my child when the programme ends.
Name of parent/guardian/participant if over 18years: …………………………………………………………………………
Signed:…………………………………………………….Date: ………………………………………………………………………..
OCTOBER HALF TERM 08
SPORT PROGRAMME
| | Monday | Tuesday | Wednesday | Thursday | Friday |
| | | | | | |
| Date | 27th October | 28th October | 29th October | 30th October | 31st October |
| Time | 10 – 4pm | 10 – 4pm | 10 – 4pm | 10 – 4pm | 10 – 4pm |
| | | | | | |
| Activities | Football | Football | Football | Football | Football |
| | Basketball | Handball | Basketball | Handball | Basketball |
| | Tennis (2- 4pm) | Tennis (2- 4pm) | Tennis (2- 4pm) | Tennis (2- 4pm) | Tennis (2- 4pm) |
| | The Art Workshop | The Art Workshop | Badminton | Gym | Badminton |
| | Boxing (2- 4pm) | Boxing (12-2pm) | Dance, Boxing (2- 4pm) | Boxing (12-2pm) | Boxing (12-2pm) |
| | | Gym | | | |
www.thesportactionzone.org
Karim Habibi
Activities Co-ordinator
North Southwark & North Lambeth Sport Action Zone
Lilian Baylis Old School
T: 020 3268 0012
F: 020 3242 0004
M: 07982 705392
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