will be running a week of

Monday 3rd July to Thursday 6th July 2017

From 6.30pm to 8.30pm for Age 7-11 Years
At The 3G Pitches at Omagh Leisure Centre
 Omagh Baptist Church - Soccer Camp Registration Form
WORLD CUP Full name of child: ___________________________________________________M / F
Date of Birth:________________________ School Year / Class____________________
Address: ________________________________________________________________
TOURNAMENT E-mail address: ___________________________________________________________
Phone number where I can be contacted in an emergency:

ON THURSDAY, Home:_______________________________ Work: _____________________________

Mobile: _________________________________________________________________
If unavailable contact:
PRIZES & BBQ ON FRIDAY Name: __________________________________________________________
Phone no. (Including code): _________________________________________

AT CHURCH Relationship to child: ______________________________________________

Name and phone number of GP: ___________________________________________

Please remember to bring
football boots, shin pads,
a coat and a drink
For further information please contact
Julie Ellis
36 Claremore Road, Castlederg, Co. Tyrone, BT81 7RF.
Tel: 028 8122 8705 / 077 4394 3279
Only limited places availableyou must be pre-registered to
avoid disappointment on the night
Details of any medical conditions or allergies ( eg. Asthma / diabetes / epilepsy) and any
medication
_______________________________________________________________________
Any other special needs, requirements or directions that would be helpful for leaders to
know about:
_______________________________________________________________________
_______________________________________________________________________
I will inform the leaders of any changes to my childs health, medication, needs and also to any changes
of address or phone numbers given.
In the event of illness or accident, having parental responsibility for the above named child, I give per-
mission for first aid to be administered where considered necessary by a trained first aider, if available,
or by a suitably qualified medical practitioner .
If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult
leader to sign on my behalf any written form of consent required by the hospital. However I understand
that every effort will be made to contact me as soon as possible.

Please post all completed registration forms no later than Friday
30th June to Julie Ellis
Any updates will be on our Church Facebook Page:
www.facebook.com/OmaghBaptistChurch
During the time your child will spend with us photgraphs/video filming may be taken for general purpos-
es and for this we need your permission. On signing this form we assume you have given permission
unless you inform us otherwise.
Signature of parent / guardian _________________________________Date: _________________
Name Printed in full:_______________________________________________________________