Page 23 - SportKontakt 16/2018
P. 23
pagina 12
INSCHRIJFFORMULIER OLYMPISCHE WINTERSPELEN
Lyra team *
Aantal personen *
Namen deelnemers *
Aantal tenten *
Begeleider 1: Naam *
...................................................................................................................................................................................................................................................................................... ...................................................................................................................................................................................................................................................................................... ...................................................................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................
In bezit van EHBO/BHV diploma * ja, EHBO ja, BHV
nee, geen van beiden
Telefoonnummer begeleider 1 * .............................................................................................................................................................................................................................................................
E-mail begeleider 1 * ......................................................................................................................................................................................................................................................................................
Begeleider 2:
Naam* ......................................................................................................................................................................................................................................................................................
In bezit van EHBO/BHV diploma * ja, EHBO ja, BHV
nee, geen van beiden
Telefoonnummer begeleider 2* .............................................................................................................................................................................................................................................................
E-mail begeleider 2 ...................................................................................................................................................................................................................................................................................... Voedselallergieën ...................................................................................................................................................................................................................................................................................... Teamnaam ouderkind voetbal * ............................................................................................................................................................................................................................................................ Overige bijzonderheden ......................................................................................................................................................................................................................................................................................
* = verplicht
LYRA
FAMILIEWEEKEND
OLYMPISCHE
