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5th Annual Winter Club Competition Entry Form

5th-Annual-Winter-Club-Competition-       Entry-Form

SFTF 5rd competition in IVY

 

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. E-mail
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           _________________________________________

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