Page 28 - SportKontakt 19/2018
P. 28
pagina 15INSCHRIJFFORMULIER OLYMPISCHE WINTERSPELENLyra team * ...................................................................................................................................................................................................................................................................................... Aantal personen * ...................................................................................................................................................................................................................................................................................... Namen deelnemers * ...................................................................................................................................................................................................................................................................................... Aantal tenten * ...................................................................................................................................................................................................................................................................................... Begeleider 1: Naam * ...................................................................................................................................................................................................................................................................................... In bezit van EHBO/BHV diploma * ja, EHBO ja, BHV nee, geen van beidenTelefoonnummer begeleider 1 * ............................................................................................................................................................................................................................................................. E-mail begeleider 1 * ...................................................................................................................................................................................................................................................................................... Begeleider 2: Naam* ...................................................................................................................................................................................................................................................................................... In bezit van EHBO/BHV diploma * ja, EHBO ja, BHV nee, geen van beidenTelefoonnummer begeleider 2* ............................................................................................................................................................................................................................................................. E-mail begeleider 2 ...................................................................................................................................................................................................................................................................................... Voedselallergieën ...................................................................................................................................................................................................................................................................................... Teamnaam ouderkind voetbal * ............................................................................................................................................................................................................................................................Overige bijzonderheden ...................................................................................................................................................................................................................................................................................... * = verplicht
