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South Bromsgrove High
Teaching School
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South Bromsgrove Soccer School
Child's Name
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Date of Birth
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Address
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Doctor's Name & Address
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Contact Name & Number
1st Contact
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2nd Contact
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3rd Contact
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Any Medical Information
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Any other information we would need to know
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Booking Dates
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Tuesday 21st February
Wednesday 22nd February
Thursday 23rd February
Payment £30 per day / £75 for 3 days
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Cheque (payable to South Bromsgrove High)
BACS (please put name as reference) Bank: Lloyds Bank plc Account name: South Bromsgrove High Sort code: 30-63-94 Account number: 27726260
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