BURPHAM PRIMARY – SURREY RAMS AFTER SCHOOL BASKETBALL CLUB ONLINE REGISTRATION If you are human, leave this field blank.Burpham Primary - After School Surrey Rams Basketball Club Registration/Payment Form Dear Parents Welcome to the online Burpham Primary 2023-2024 After-School Surrey Rams Basketball Club Registration/Payment Form. All forms will be sent to the Surrey Rams online Registration database. If parents have any questions please feel free to email the Surrey Rams Admin team: admin@surreyrams.net PLEASE NOTE THE DATES FOR THE 7 WEEKS AFTER SCHOOL CLUB IS: 6TH SEPTEMBER- 18TH OCTOBER 2023 THE RAMS AFTER-SCHOOL BASKETBALL CLUB WILL BE HELD ON THE M.U.G.A (Multi Use Games Area). BURPHAM PRIMARY AFTER-SCHOOL SURREY RAMS BASKETBALL CLUB COST *Please note the sessions will cost £42.00 (£6.00 Per session) for the 7 weeks ADDITIONALLY, PLEASE NOTE THAT ONCE THE CLUB HAS STARTED, UNFORTUNATELY NEW STUDENTS CANNOT JOIN AFTER THE FIRST SESSION HAS COMMENCED. Please note that is a first come first served offer as there is a limit of 15 students per session. Once club spaces are filled, students will be put on the waiting list for the Spring term course. If you are interested, WE ADVISE FILLING COMPLETING THE ONLINE FORM AND MAKING ONLINE PAYMENT ASAP AS THIS WILL SECURE YOUR CHILD'S PLACE ON THE COURSE. (as many parents know from past courses, the Rams after-school basketball course has always been filled to capacity). Payment options. Option 1 (Preferred method) Payment due before 1st August 2023, Online Payment - Account details: Account name: Surrey Rams Basketball Club CIC Account number: 70721160 Sortcode: 30-96-26 Reference:ChildName_BurphramPrimary Option 2: Card payment - Payment due on 6th September 2023 (Parents are able to pay using our club connect card machine).Please select your child's year group: *Use the drop down menu to select age group.Year 3Year 4Year 5Year 6Please enter child's class name: *Please select payment option: *Option 1) Online PaymentOption 2) Debit or Credit Card Payment Please indicate if your child will: be collected (please state who), going to external club (please state external club) or going home on their own *STUDENT DETAILS:Please enter student's first name *Please enter student's last name *Please enter student's address *Apt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityZip codePlease enter student's D.O.B(please use the following format i.e - 01/01/2001)EthnicityWhilst it is not compulsory that the following section is completed the footnote at the end of this template explains why it is important.White - BritishWhite - IrishWhite - other Mixed - White & Black CaribbeanMixed - White & AsianMixed - White & Black Africanother mixed backgroundAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - Bangladeshiother Asian backgroundBlack or Black British - CaribbeanBlack or Black British - AfricanBlack or Black British - other black backgroundChinese or other ethnic group - ChineseChinese or other ethnic group - other ethnic group not listedother - not listedMedical information - Additionally, please include if child’s have medicine in school that needs to be collected from school office? *Please detail below any important medical information that our coaches/ Junior Coordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.)Does the student consider himself/herself to have a disability? *The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities’.YesNoEMERGENCY CONTACT DETAILS:Please enter parent/gaurdian mobile number *Please enter parent/gaurdians home telephone number. *Instructions* Neither the mobile number nor the email should be that of the student– this could make children vulnerable and is considered poor practice. For a child/young person under the age of 16, the details should be those of the parent/carer. Emergency Contact details - Please enter full name.To be completed by the parent/carer Please enter the information below to indicate the person(s) who should be contacted in event of an incident/accident. Please enter emergency contact number *Please enter student's parent/gaurdian full name *for example: John SmithPlease email parent/gaurdian email address *Please select which statement is applicable to parent's/career declaration *I agree to my son/daughter in my care taking part in the activities of the clubI DO NOT agree to my son/daughter in my care taking part in the activities of the clubSurrey Rams Promo and particapation declarationBy submitting this completed form, I agree to my son/daughter/child in my care taking part in the activities of the Surrey Rams Basketball After-School Clubs. Additionally by completing this form, I agree to adhere to the code of conduct for parents/carers and my child shall adhere to the code of conduct for Surrey Rams Basketball After-School Club. I understand that I will be kept informed of these activities – for example timing and transport details. I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. To comply with the Data Protection Act 1998, we need your permission before taking any images of your child for future advertising and promotion purposes. If you do not wish your child’s photograph to taken or used in any promotional material please tick this boxPlease select one of the following regarding promo declaration *I DO give consent for my child's picture/video to be taken and used for Surrey Rams promotional purposes on social media sites, flyers, ect.I DO NOT give consent for my child's picture/video to be taken and used for Surrey Rams promotional purposes on social media, flyers, ect.Submit