West Ham United Football Club
Mascot Application Form
2010/2011 Season
Laura Tucker Fax: 0208 548 2757 Email: [email protected]
Ticket Office, West Ham United Football Club, Boleyn Ground, Green Street, Upton Park, E13 9AZ
West Ham United Football Club
Mascot Application Form
West Ham United Vs……………………………… Date of Match………………… Kick off…………
Your Name (Mr, Mrs, Miss) ………………………………………………………………………….......
………………………………………………………………………………………...
Your Address
……………………………………………………………Post Code …………………………………........
Telephone No …………………………………………...Mobile
Email
……………………………………….
………………………………………………………………………………………………..
Your Relationship to the Child …………………………………………………………………………….
(If you are not the Parent/carer of the child, please ensure you gain the parents/carers consent below)
CHILD’S DETAILS: Name …………………………………………………DoB …………………………………….
This personal information will appear in the Match Day programme. If you do not wish the child’s first name,
surname, age or other information to appear, please leave the space(s) blank. Please complete with the child.
My Preferred Name*……………………………………………………………My Age*………………………………
My Favourite Player*……………………………………………………………………………………………………..
My Hobbies*……………………………………………………………………………………………………………….
Parent’s/Carer’s Consent
I consent to my child taking part in the activity and being a Match Day Mascot. My child is in good health and I consider him/her
capable of taking part in the activity. I have read and agree to respect the guidelines and policies of the Match Day Mascot Policy. I
also understand that whilst Club personnel will take every precaution to ensure that accidents do not happen, they cannot
necessarily be held responsible for any injury to my child.
Images and Personal Information
I consent to images (photographs, film or video) of my child being taken and reproduced by West Ham United or by key partners
for publications to promote the Club, the activity and football and may appear in the public domain - this includes Away Mascots
who may appear in Club publications. I understand that the image I provide appears with the personal information provided above
in the Match Day Programme and I consent to this. I confirm that my child is not subject to family, care or legal proceedings.
Note: By accepting the mascot placement, you are agreeing that we can use the personal information you send us for purposes
connected with the administration of this placement.
First Aid/Medical
It may be necessary for qualified personnel to have the necessary authority to administer or obtain any immediate treatment which
may be required whilst on the activity and I consent for emergency treatment to be administered. Please note any allergies, medical
conditions or special needs on this form.
Medical (eg, asthma, allergies):………………………………………………………………………………………………….
Name (parent/carer, please print) ……………………………………………………………………………………………….
Signature ……………………………………………………………………..Date ……………………………………………..
This form will only be processed with the parent/carer consent and signature.
Please return by post at least 10 days prior to the fixture, together with a Passport Size Photograph, this image will appear in the
Match Day Programme. Send to: Laura Tucker, Mascot,Co-ordinator,West Ham United Football Club, Boleyn Ground, Green
Street, Upton Park, London E13 9AZ
West Ham United Football Club
Mascot Package Agreement
This is to confirm that I agree to purchase a Matchday Mascot Package for:
Name of Child
………………………………………………..Age………… DoB…………………………
For West Ham United home game with…………………………………………………………………..FC
On whatever date and time that this match is played. At present this is scheduled for :
Day……………..Date……….……..with Kick Off at…….…..pm – but all matches are subject to change
The package includes the following:
Mascots to walk out with the team prior to kick off.
Pre-match training on the pitch.
2 match day tickets (1 ticket must be used by the mascot.)
Mascot souvenir pack.
Photos of the mascot’s day (This will be sent out 3-4 weeks later.)
DVD containing match highlight and footage of the mascot’s day (This will be sent out 3-4 weeks later.)
Photograph & details in the Matchday programme.
The price of the package is to be paid in full at least 4 weeks prior to the match date.
Cancellation: Please note that we cannot guarantee a refund for late notice of seven days or less before
a game.
Signature ………………………………………………………………..Date ………………………………
Name
………………………………………………………………………………………………………
Address ………………………………………………………………………………………………………
…………………………………………………………………………..Postcode ……..……………………
Contact Nos ……………………………………………………………Mobile …………………………….
Email ………………………………………………………………………………………………………….
Please indicate method of payment (tick one box)
Cheque*
Credit/Debit Card
*Cheques to be made payable to West Ham United FC PLC
Credit/Debit Card No: __ __ __ __ __ __ __ __
Expiry Date __ __ / __ __
__ __ __ __
Valid From __ __ / __ __
__ __ __ __
Issue No: __
CVV No: __ __ __
Card Holders name and address if different from applicant:
………………………………………………………………………………………………………………….
Signature of Cardholder ………………………………………………Date ……………………………….
I agree that West Ham United FC PLC is authorised to debit my credit/debit card in respect of the above mascot
package and that I am the cardholder and reside at the above address
Please complete and return to: Laura Tucker, Mascot Co-ordinator, West Ham United Football Club, Boleyn
Ground, Green Street, Upton Park, London, E13 9AZ