Detail as follows:

o Date: Wednesday 19th November 2014

o Venue:Southglade Leisure Centre, Southglade Road, Bestwood, Nottingham, NG5 5GU

o Time:12.30pm – 2.30pm

o Age: 5 to 19 years

o Price: £5 per person

o Contact: Katy Johnson on 01159257027 or email at katy.johnson@cpsport.org

Registered Charity No. 1088600

Project supported by:

Making Fun Happen

Sportstart Day

Visit www.cpsport.org | follow @cpsport

CP Sport Sportstart Day Reply Slip/Photo Consent Form I would like to attend the Sportstart Day on Wednesday 19 th November Southglade Leisure Centre, Southglade Road, Bestwood, Nottingham, NG5 5GU

Name  

Address  

 Post Code    Telephone  

Email  Date of Birth    Age   School  

Ambulant   

Manual wheelchair user   

Electric wheelchair user   

Please tick as appropriate:

Medical Condition (if applicable): Name of parent/ Guardian: Emergency contact details (if different from above): Name: Relationship to young person: Contact Number: All children must be accompanied by a parent, carer or teacher

 We would like to take photographs for promotional purposes. These images may appear on the CP Sport web site or used in Funding Applications. To comply with Data Protection Act 1998, your permission is required before we take any photographs.  

Please return form and contact for BACS payment details for £5 entry fee:Katy Johnson Email: katy.johnson@cpsport.org Tel: 0115 925 6442

CP Sport, 5 Heathcoat Building, Nottingham Science and Technology Park University Boulevard, Nottingham, NG72QJ

I do / do not give permission for my son/daughter’s image being used in display material to advertise and promote CP Sport.Name of parent/ Guardian:

Signed …………………………………………………. (Parent/guardian)