Sports DevelopmentFort Regent, St Helier JE2 4UX

Telephone +44 (0)1534 449617Fax +44 (0)1534 449825Email sport@gov.je

Education, Sport and Culture

Fun Activities at Fort Regent (Queens Hall) for 7 – 15 year olds Every Tuesday and Thursday from 4.30pm to 5.30pm

£2.30 per session – pay at reception

Spinning with Sue at Les Quennevais Sports Centre for 12 – 15 year olds Every Monday and Thursday from 4.45pm – 5.30pm.

£3.75 per session or free to active card holders – pay at reception

Circuit training with Adrian at Les Quennevais Sports Centre for 12 – 15 year olds Every Tuesday from 4.45pm – 5.45pm

£3.75 per session or free to active card holders – pay at reception

Trampolining with David at Fort RegentFor 7 – 9 year olds £30.00 for the 8 week course / 3.45pm – 4.45pm

2220 Wednesday 1 May – Wednesday 17 July (no class 29 May or 5 June,12 June & 26 June)

Trampolining with David at Fort Regent For 10 year olds and over £30.00 for the 8 week course / 4.45pm – 5.45pm

2221 Wednesday 1 May – Wednesday 17 July (no class 29 May or 5 June,12 June & 26 June)

Football at Springfield with Martin For 5 & 6 year olds £45.00 for the 12 week course / 3.45pm – 4.30pm

2216 Wednesday 17 April – Wednesday 10 July (no class 29 May)2218 Friday 19 April – Friday 12 July (no class 31 May)

Football at Springfield with MartinFor 7 year olds and over £45.00 for the 12 week course / 4.30pm – 5.15pm

2217 Wednesday 17 April – Wednesday 10 July (no class 29 May)2219 Friday 19 April – Friday 12 July (no class 31 May)

Fencing at Langford with Gianpaolo For 8 - 14 year olds £37.50 for the 10 week course / 6pm – 7pm

2213 Monday 22 April – Monday 8 July (no class 6 May or 27 May)

Cricket at Oakfield Sports Centre for school years 3, 4 & 5 £22.50 for the 6 week course / 6pm – 7pm

2222 Wednesday 5 June – Wednesday 10 July

Cricket at Oakfield Sports Centre for school years 6, 7 & 8 £22.50 for the 6 week course / 7pm – 8pm

2223 Wednesday 5 June – Wednesday 10 July

For further information please email sport@gov.je or visit www.gov.je/sport

Find us on facebook at www.facebook.com/SportsDevelopmentJersey

Tweet us @jerseysport

Please return to: Sports Development, Fort Regent, St. Helier, Jersey, JE2 4UXData Protection Law (Jersey) 2005 The information provided by you on this form is required by the Sport & Leisure Division for the purpose of course enrolment and coaching requirements. Children’s information supplied by you may be disclosed to sports coaches. Financial details provided will be securely disposed of at the end of each course.

Child’s Name: Date of Birth:

Home Address:

Post Code:

Tel. Day: Tel. Eve:

Emergency Contact Name & Tel. Number:

Email: School Attended:

Please list allergies and statement of special needs, etc.):

I consent to my son/daughter’s participation. I undertake to see that my son/daughter is provided with the required clothing/equipment where appropriate. I permit my son/daughter to be transported in departmental minibuses. To the best of my knowledge, my son/daughter is medically fit to participate in the activities involved and I undertake to inform you in advance of any alteration to this position. I consent to my son/daughter being given emergency medical treatment.

Please notify us in writing if your son/daughter is being collected from an activity by another adult or if your son/daughter is able to make their own way home. All courses have limited availability and are offered on a first come, first served basis. Early booking is advised. Sports Development reserves the right to cancel or amalgamate classes where necessary. Please note that requests for refunds must be made in writing to Sports Development at least one week before the course start date. Please list your course requests below. We are unable to process refunds under the value of £7.

Course Code Activity Description Amount

Method of payment: Cheques should be made payable to “Treasurer of the States”.Or Credit/Debit card number

Valid From / Expiry Date / Issue No.

Name of Cardholder

Cardholder’s Signature

Parent’s Signature: Date: