SquashFit Bursary application
SquashFit – Funded through Buckinghamshire Youth Bank & The Nic Willoughby Funds. Granted by Heart of Bucks, our community foundation.

SquashFit is a grant funded programme which aims to:
1. Offer local children the opportunity to try a new sport, squash, in school and in a local, safe, club environment at Wycombe Squash & Racketball Club.
2. Improve/ promote young people's physical, mental and emotional health with squash.

As a result of COVID-19, WSRC is delighted to confirm that Heart of Bucks has approved a year’s extension on the grant to, September, 2021. Along with the extension, Heart of Bucks has agreed for bursaries to be made available to existing U19 members whose families have been affected directly or indirectly by COVID-19. The bursary includes: club membership, coaching & equipment.

Reporting
Successful applicants will be required to take part in simple questionnaires* (at the start, halfway point and at the conclusion of the programme) to monitor and assess impact:
*Activity, mental wellbeing /confidence (WEMWBS) and social cohesion
Attendance records will be tracked.

All details will remain confidential.
Contact Heidi Leseur for more info: buckssquashdevos@gmail.com or 07974 962 445
Applicants name *
Applicants Address *
Parent/Carer's name *
Parent/Carer's contact email *
Parent/Carer's contact number *
Is the applicant a member of WSRC? *
How did you hear about the Bursary? *
Why are you applying for the bursary? *
Please tell us why you are applying? Please tell us how or if you have been affected by COVID-19 e.g. income, mental health, other? How will the bursary help you if you are awarded?
Medical Information:
Do have any conditions or allergy requiring medical treatment, including medication? If yes, please give brief details:
Medical Treatment: *
Medical Details:
Details of any conditions or allergy that requires medication:
Receiving Medication: *
I agree to the junior member receiving medication as instructed and any emergency dental, medical or surgical treatment including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.
Changes in Medical: *
I will inform the club manager as soon as possible of any changes in the medical or other circumstances whilst my child is engaged in the above activities.
Family Doctor: *
Please supply details of your Doctor's Surgery / address / phone.
Emergency contact: *
Name and number of additional contact in case of emergency.
Activities:
Participation in, junior coaching, training activities, general play, competitions and representative matches for the club.
Activities Participation: *
Required
Photography & Recorded Images
Photography, Recorded Images & Social Media: WSRC recognises the need to ensure the welfare and safety of all young people in sport. Our Photography & Recorded Images and Social Media Policies are on the WSRC website, please indicate that you have read and give consent for the use of said images on WSRC social media platforms, marketing and coaching tools.
Photography & Recorded Images Consent *
Terms & Conditions *
Have you read and do you accept the terms & conditions of the bursary?
Wycombe Squash & Racketball Club *
Have you read and do you accept the Wycombe Squash & Racketball club guidelines and WSRC COVID guidelines? https://www.wycombesquash.co.uk/resources
Question *
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