5th-Annual-Winter-Club-Competition- Entry-Form
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5th Annual Winter Club Competition 2013 ENTRY FORM
Unit 12 St Lawrence Business Centre, Victoria Road, Feltham, TW13 7LT United Kingdom
SUNDAY, 15th DECEMBER 2013
Weigh-in 8:30 am – 9:30 am Start 10:30 am (subject to change depending on numbers) |
Please complete this form fully and in BLOCK CAPITALS
| Name | ||||
| Address | ||||
| Post Code: | ||||
| Date of Birth | / / | Gender | ||
| Contact Phone No. | ||||
| Club: | BWL or School Membership No. | |||
| BWT Class – Please circle (or shade) the correct value | |||||||||||||||||
|
Men: |
56 |
62 |
69 |
77 |
85 |
94 |
105 |
105+ |
Women: |
48 |
53 |
58 |
63 |
69 |
75 |
75+ |
Senior |
|
Men: |
56 |
62 |
69 |
77 |
85 |
94 |
105 |
105+ |
Women: |
48 |
53 |
58 |
63 |
69 |
75 |
75+ |
Under 23 |
|
Men: |
50 |
56 |
62 |
69 |
77 |
85 |
94 |
94+ |
Women: |
44 |
48 |
53 |
58 |
63 |
69 |
69+ |
Under 17 |
|
Men: |
45 |
50 |
56 |
62 |
69 |
77 |
85 |
85+ |
Women: |
40 |
44 |
48 |
53 |
58 |
63 |
63+ |
Under 15 |
| Total Achieved | ||
| Current Age | Years: Months: | |
l You should note that the closing date for entries is the 5th December 2013. No entries will be accepted after the deadline date.
l Your BWL membership book (or School membership number) will be collected at the weigh-in for the duration of the competition.
l Competitors will be notified of any changes to the above details, e.g. weigh in time / start times etc.
l With this entry form you must enclose the following:
Entry Fees Under 17’s £ 8.00
Under 23’s £ 10.00
Over 23’s £ 15.00
made payable to ‘Stars For The Future’ and sent the Head Coach or transfer the entry fee money through the bank
Sort Code: 60-70-05
Account Number: 50576828
Account Name: Stars for the Future
Please return to Kazem Panjavi, Flat 138 Curlew Court, Gurnell Grove, West Ealing, London, United Kingdom, W13 0AH. Email: kazem@starsforthefuture.com
STARS FOR THE FUTURE (SFTF)
UNDER 18 PARENTAL CONSENT AGREEMENT FORM
I _______________________________ (name) of ___________________________________
_____________________________________________________________________ (address)
Confirm that I have parental / guardian authority for
_________________________________________ (athlete’s name)
I confirm that:
(1) I give permission for my son / daughter to compete in the 5th Annual Winter Club Competition on 15th December 2013 and confirm that he / she is physically fit to undertake the sport of weightlifting.
(2) My son/daughter is taking/not taking* a prescribed medication by our doctor or pharmacist (delete where appropriate).
If your child is taking any medication then contact kazem@starsforthefuture.com immediately for advice.
(3) I consent to photographing and videoing of my child in the weightlifting competition under the stated rules of the BWL Safeguarding & Protecting Children and Young People in lifting Policy and Procedures.
Signed _________________________________________
Date _________________________________________