Football Block Booking Application

Please tick to confirm you have read and understood this.*

Hirer Name *

Team Name

Team Address *

Team Postcode *

Home phone number

Mobile phone number *

Email address *

Confirm Email address *

Are Treasurer details the same as Hirer’s? *

Yes

No

Treasurer name *

Treasurer Address

Treasurer home phone number

Treasurer mobile number *

Treasurer email address *

Confirm Treasurer email address *

Activity to be undertaken *

Venue required *

Springwood Leisure Centre (open Mon - Fri 9am - 10pm, Sat 9am - 6pm, Sun 9 am- 8pm)

Number of pitches *

1 pitch

2 pitches

Day required *

Time required from (on the hour only available at Springwood) *

Time required to (on the hour only available at Springwood) *

Start date for booking *

End date of booking (max. date 31.03.2025) *

Exclusion dates

Adult or Junior *

Adult

Junior

Payment options (Springwood) *

Monthly direct debit

Monthly invoice

Upload Direct Debit mandate *

Are you an Affiliated Team? *

Yes

No

Please upload your current affiliation details *

Do you have a current Risk Assessment? *

Yes

No

By ticking this box you are agreeing to follow the Government and FA Guidance that is in place during your booking *

Yes

Please upload your current Risk Assessment

Do you have England Football Accreditation (previously called Charter Standard)? *

Yes

No

Please upload Charter evidence here *

Additional information (please provide any further information you feel is relevant to your booking)

I agree to the terms and conditions *

Yes

I understand that if my payments are not made on time my booking will be suspended until outstanding invoices are cleared *

Yes

Send me Derby Parks information by email

Send me Derby Active information by email

Send me Derby Active information by post

Send me Derby Active information by phone/SMS

Football Block Booking Application

Contact details

Booking information