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Burger King Choose Sport Application
To be completed by approved referrer
Applicants Name
*
Date of Birth
*
Address
*
Phone Number
*
Mobile
Existing Member of a Club
*
Yes
No
No of Seasons
1
2
3
4
Parent/Caregiver Declaration
Parent/Caregiver Name
*
Phone Number
*
Mobile
I have read the grant conditions and support this application
Consent
*
Yes
No
Date
Approved Referrer
Referrer Name
*
Organisation
*
Position
*
Address
*
Ph: Work
*
Ph: Home
*
Mobile
Sports Club ( name of the club you wish to join)
*
Season Start Date
*
Application Details
To be completed by the referrer and should include how the applicant meets the grant criteria, how the referrer knows the applicant, why the applicant wishes to join a club and any other supporting information.
Details
*
Grant Amount
Item Requested ( membership, equipment)
*
Amount Requested - Please list individual item and amount
*
Approved Referrer Declaration
I have read and understood the grant conditions and understand that I am making this application on behalf of the named applicant. I also declare that to the best of my knowledge, the applicant meets all of the grant criteria and that I am responsible for communicating with the applicant in regards to this grant and ensuring that the grant conditions are met.
Consent
*
Yes
No
Date
*
Captcha:
*
For a printable version of the form please click
BKChoose_Sport_Application_Form.pdf