WheelPower British Wheelchair Sport. Fifteenth Stoke Mandeville Junior Sports Camp Saturday 17th and Sunday 18th November 2012

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1 Fifteenth Stoke Mandeville Junior Sports Camp Saturday 17th and Sunday 18th November 2012 WheelPower - British Wheelchair Sport will be hosting the Fifteenth Junior Sports Camp at Stoke Mandeville Stadium, Aylesbury on Saturday 17th and Sunday 18th November. Entry, Accommodation and Payment forms are attached. Completed forms should be returned by Wednesday 7th November The Junior Sports Camp is open to youngsters aged with a physical impairment. The camp will provide the opportunity to receive coaching in a number of Paralympic Sports. The Sports on offer will include Archery, Basketball, Cue Sports, Powerlifting, Rowing, Shooting, Swimming and Table Tennis. The session times will be Saturday and Sunday Coaching will take place on Saturday and Sunday morning. The weekend will conclude with a mini competition in all the sports on the Sunday afternoon. Accommodation, if required, will be available on Friday and Saturday night at the Olympic Lodge, Stoke Mandeville Stadium. The entry fee is: Saturday and Sunday Saturday only 6.00 Sunday only 5.00 Lunch will be provided on both days. If you require any further information please do not hesitate to contact on or stewart.jeeves@wheelpower.org.uk. An electronic version of this letter is available. We look forward to welcoming you to the Camp. Stewart Jeeves Sport Development Officer, WheelPower September 2012

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3 Entry Form To be returned by Wednesday 7th November 2012 PLEASE COMPLETE IN BLOCK CAPITALS AND IN FULL Participant details Title Surname First name(s) Telephone Date of birth / / Age Brief description of impairment: Post Code Please indicate if you are a manual, power wheelchair user or ambulant: Powered Manual Ambulant Parent/Guardian/Personal Assistant contact details All participants must be accompanied by a responsible Parent/Guardian/Personal Assistant. Title Surname First name(s) Post Code Telephone Mobile WheelPower greatly values your support and would like to keep you informed about future WheelPower events. Please tick the box if you do not give your permission for this

4 Sports Please tick the Sports in which you would like to take part at the Junior Sports Camp. Archery Basketball Cue Sports Powerlifting Rowing Shooting Swimming Table Tennis Accommodation To be returned as soon as possible and no later than 7th November 2012 We shall not require accommodation for the Junior Sports Camp We shall require accommodation for the Junior Sports Camp Date of Arrival Date of Departure Day Month Year Day Month Year Name(s) for accommodation (please list any additional persons overleaf): Special Requirements: Catering Lunch will be provided on both days free of charge. Breakfast and Dinner are available at an extra charge (see Payment Form for details) Dietary Requirements (including parent/guardian/carer if attending):

5 Medical and Photo Consent Form PLEASE COMPLETE IN BLOCK CAPITALS Name Date of Birth / / Post Code Tel(home) GP s Name Tel(mobile) Tel Is there anything we should be aware of to ensure your well-being? YES NO If yes please give details: Are you allergic to penicillin? YES NO Photography I understand that WheelPower and its partners may take photographs during the event and permit them to use the images for promotional purposes, including its website. Please tick the box if you do not give your permission for this Please note; it is difficult to ensure an individual is not included by error in group or action shots

6 Medical Consent I consent to any emergency medical treatment in the event of an accident Signed (parent/carer if under 18):. Print Name:.. Date: Payment Form Fees must be paid in full with the Entry Form and received by WheelPower by Wednesday 7th November Registration for the event cannot be confirmed until payment has been received. Refunds can not be issued unless 1 week s notice of cancellation is received prior to the start of the event unless there are exceptional circumstances. Please note entry fee is applicable for each individual attending. E.g. if parent and participant are attending the entry fee for Saturday and Sunday will be Accommodation in the Olympic Lodge (prices per person) Junior Camp Entry Fee (prices per person) Cost Amount Total Two nights One night Breakfast (per meal) 3.00 Dinner (per meal) 5.00 Saturday and Sunday Saturday only 6.00 Sunday only 5.00 *Lunch will be provided on both days free of charge Overall Total Payment by Cheque/Postal Order Cheques, etc should be made payable to: WheelPower Enclosed within this entry form for the Junior Camp is a cheque for Payment by Credit Card (Visa, Visa Debit, Mastercard) If you wish to pay by Credit Card please complete the form below in block capitals:

7 Title Initials Surname Card Numbe Valid From Issue No. Expiry Date Security No. (last 3 digits below magnetic strip) Please debit my account sterling in payment for entry and accommodation/catering for the Junior Camp. Signature Date / /