George Salter Academy
Facility Booking, Application Form.
Team / Booking ______________________________________________
www.georgesalter.com
Tel : 01215534665
Fax : 01215255082
Contact person __________________________________________________
Address ________________________________________________________
_______________________________________________________________
Post Code
______________________________________
Email
____________________________________
*Contact Number
____________________________________
*Home phone Number
____________________________________
(* both required for authorisation of booking)
Facility required – circle as appropriate:
Sports Hall
Astro
Dance Studio
Small Astro
Gym
Netball Courts
Classroom
West Hall
Booking Time:
Activity Used for
Grass Pitches
Day(s):
…………………………………………………………….
Do you have any George Salter C.A. pupils participating YES / NO?
If yes names? - ………………………………………………………………….
Qualify for reduction –
YES
/
NO
Monitoring –
Adults : Male -
Female -
Children U16 -
Of which are Ethnic Minorities –
Payment method preferred – Invoice
/
cash
/
cheque
/
Office Use Only:
Service level agreement
Date:
Additional Information:
Application
Accepted
/
Declined
Please return completed form to a member of the George Salter Sports Development team at
Community Reception or post back to – Rashmi Patel, community@georgesalter.com
George Salter Academy, Claypit Lane, West Bromwich, B70 9UW.