Vince Nicoll Goalkeeping Schools

Held at Marshalls Park School Pettits Lane Romford.

Starts 10:00am - 15:30pm      

 Child's Name ---------------------------------------------------------------------------------

Date of Birth----------------------------------------------------------------------

Home Address…-------------------------------------------------------------------

Home Number    -------------------------------------------------------------------

Mobile Number  -------------------------------------------------------------------

Emergency Number  ---------------------------------------------------------------

Email address ---------------------------------------------------------------------

Any medical conditions-----------------------------------------------------------

 I enclose a cheque for £20

 Please make cheques payable to Vince Nicoll

 Parental internet and media consent: We operate our own club website, http://www.vincenicollgoalkeeping.com/

Information from the goalkeeping schools may appear on it.

 We may use pictures of the children, but this will be ONLY WITH YOUR PERMISSION.

 I agree/do not agree (delete as appropriate) for pictures of the child named above to appear on the Vince Nicoll goalkeeping school website

 Parent/Guardian’s Name...................................................................................................

 Parent/Guardian’s signature.............................................................................................

 Date...............................................................

 Completed form and cheque to: Vince Nicoll 24 Havers Lane Bishop Stortford Herts CM23 3PB