Worthing Academy Enrolment Form

    This form is for enrolment with Worthing Academy

    Personal Details

    First Name *

    Surname *

    Date of Birth *

    Address *

    Town *

    Postcode *

    Contact No. *

    Emergency Contact Name and No.*

    Email *

    Medical Information

    Provide details of any medical conditions or disabilities which should be brought to the attention of the managers and coaching staff.

    Use of Photographic Media for Publication

    This section needs to completed by the player if he or she is 12 years or older or, by the parent/guardian if the player is under the age of 12.

    I consent to Worthing Academy photographing or videoing me/my child’s involvement in cricket and to my/his/her name being published with any photograph in any authorised event publication or press article.

    Accepted

    Age Group

    Juniors are placed in groups according to age and gender. In accordance with the table shown on the Academy website page, please tick the group applicable for your child:

    Girls School Years 6 to 12

    Courses now full for Boys and Girls School Years 3 to 5 and Boys School Years 6 to 12

    Payment

    For all group categories, payment is by Bank Transfer to Stumpy's Cricket. A single fee of £180, or 3 monthly instalments of £60 payable in Sep, Oct and Nov, applies.

    Bank Transfer is via: The Co-Operative Bank, Sort code 08-71-99, Account No. 37681390.
    Please reference the Child's name.

    Declaration

    Submission

    Fields marked * must be completed