Futsal Camp Application Form
Please complete and return to Mr Richard Horlock at Ralph Allen School making
cheques payable to Richard Horlock
Contact number: 07502 405 324
Email:richard.horlock@ralphallen.bathnes.org.uk
Child’s Full Name _____________________________________________________________________________
Email Address ________________________________ D.O.B. _____________________ Age______________
Address ____________________________________________________________________________________
________________________________________________________ Postcode ___________________________
Home Telephone No. _______________________________________Emergency No. during Camp ___________
Course venue:
Course number and date:
Amount enclosed:
RALPH ALLEN SCHOOL, 9:30am – 3pm
12th – 16th August
£75
Does your child suffer from any health problems that we should know of, if so what medication is taken?
_______________________________________________________________________________________
Is your child allowed to go home unescorted: Yes
No
School child currently attends _______________________________________________________________
Football/Futsal Club: ______________________________________________________________________
For monitoring purposes, please indicate how you found out about our camps:
Post
School
Other
I understand that Richard Horlock or the organization providing facilities, their agents and their employees
are not under any liability whatsoever in respect of personal injury, loss or damage however caused whilst
attending the futsal Camps. I understand that the boys and girls may attend and participate in the futsal
camp and I have read and accepted the conditions. In the event of an injury to my child I consent to allow
them emergency treatment by a qualified first aider and give my permission for them to be taken to hospital
if necessary.
Name and signature of parent or guardian:
Name (block capitals):_______________________________________________________________
Signature _____________________________________ Date _______________________________
Futsal Camp Application Form
Terms and Conditions
Pease read the following carefully and tick the box below to agree with T&C’s
Bookings
Richard Horlock cannot accept liability for any injury caused whilst travelling to and from our events. Richard Horlock
cannot be held responsible for any loss or damage to any personal belongings whilst in attendance on, or travelling to or
from one of our events. Due to the popularity of our events, many of them are oversubscribed. It is therefore important
to realize that for safety reasons we can only guarantee a place on ANY course to those booking in advance. Richard
Horlock operates a daily registration and de-registration policy. We only allow children to leave the course with a
suitable parent/guardian unless otherwise informed in writing. Any medical conditions that a participant may have must
be fully disclosed in writing to Richard Horlock on a separate sheet with the booking form, as well as in writing at
registration to the appropriate member of staff on the course. In the unlikely event that a child is injured on one of our
events, parental consent is given to Richard Horlock to administer Emergency Aid treatment where necessary or to
transfer the child to hospital if deemed necessary. In this event, all attempts to contact parents will be made using the
contact numbers provided.
In the unlikely event that Richard Horlock has to cancel an event for any reason, a FULL REFUND will be issued
immediately and no written request is required. Participants require a packed lunch, plenty of fluids and suitable clothing
for the conditions. For safety reasons it is COMPULSORY to wear shin pads. Richard Horlock reserves the right to
refuse permission to participate for any child not wearing shin protection.
Limitation Of Liability And Warranty
CUSTOMER AGREES THAT USE OF THE SERVICE IS ENTIRELY AT CUSTOMER’S OWN RISK. SERVICES ARE
PROVIDED ‘AS IS,’ WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING WITHOUT
LIMITATION ANY WARRANTY FOR INFORMATION, SERVICES, UNINTERRUPTED ACCESS, OR PRODUCTS
PROVIDED THROUGH OR IN CONNECTION WITH THE SERVICE, INCLUDING WITHOUT LIMITATION THE
SOFTWARE LICENSED TO THE CUSTOMER AND THE RESULTS OBTAINED THROUGH THE SERVICE.
SPECIFICALLY, WE DISCLAIM ANY AND ALL WARRANTIES, INCLUDING WITHOUT LIMITATION: 1) ANY
WARRANTIES CONCERNING THE AVAILABILITY, ACCURACY OR CONTENT OF INFORMATION, PRODUCTS OR
SERVICES; AND 2) ANY WARRANTIES OF TITLE OR WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE. THIS DISCLAIMER OF LIABILITY APPLIES TO ANY DAMAGES OR INJURY CAUSED BY
ANY FAILURE OF PERFORMANCE, ERROR, OMISSION, INTERRUPTION, DELETION, DEFECT, DELAY IN
OPERATION OR TRANSMISSION, COMPUTER VIRUS, COMMUNICATION LINE FAILURE, THEFT OR
DESTRUCTION OR UNAUTHORIZED ACCESS TO, ALTERATION OF, OR USE OF RECORD, WHETHER FOR
BREACH OF CONTRACT, TORTUOUS BEHAVIOUR, NEGLIGENCE, OR UNDER ANY OTHER CAUSE OF ACTION.
CUSTOMER SPECIFICALLY ACKNOWLEDGES THE SERVICE IS NOT LIABLE FOR THE DEFAMATORY,
OFFENSIVE OR ILLEGAL CONDUCT OF OTHER CUSTOMERS OR THIRD-PARTIES AND THAT THE RISK OF
INJURY FROM THE FOREGOING RESTS ENTIRELY WITH CUSTOMER.NEITHER THE SERVICE NOR ANY OF ITS
AGENTS, AFFILIATES OR CONTENT PROVIDERS SHALL BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL,
SPECIAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF USE OF THE SERVICE OR INABILITY TO GAIN
ACCESS TO OR USE THE SERVICE OR OUT OF ANY BREACH OF ANY WARRANTY. CUSTOMER HEREBY
ACKNOWLEDGES THAT THE PROVISIONS OF THIS SECTION SHALL APPLY TO ALL CONTENT ON THE
SERVICE.
Trademarks
All trademarks appearing on the service are trademarks of their respective owners.
I have read the above and agree
Signature: _______________________ Date: _______________________________