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Registration, Consent and Health Form
(Child)
Please provide details in the spaces provided.
All personal information will be held strictly confidential.
Please provide
(Parent/Guardian)
email address.
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* Indicates required question
Email
*
Your email
Full Name
(Child)
*
Your answer
Date of Birth
(Child)
*
MM
/
DD
/
YYYY
Full Name
(Parent/Guardian)
*
Your answer
Address
(Parent/Guardian)
*
Your answer
Phone Number
(Parent/Guardian)
*
Your answer
Your Relationship to Child
*
Your answer
I
(Parent/Guardian)
give consent for my child to participate in the activities controlled and over-watched by the ‘Mini Warriors’ instructor understanding the potential risks and danger with physical activity including the use of equipment.
*
Yes
Required
I will ensure that my child follows the ethos and guidance set by Mini Warriors Ltd - RDDP
(Respect / Dedication / Determination & Pride).
*
Yes
Required
I know of no reason why my child should not participate in any form of activities, however, should this change I will ensure that the instructor is notified prior to any session commencing.
*
Yes
Required
To the best of my knowledge, my child is free from any condition that may affect my participation in the physical activities.
*
Yes
Required
I do / do not
(select as appropriate)
consent to initial first aid being given to my child should this be necessary at any time during any session.
*
I do
I do not
I do / do not
(select as appropriate)
consent for photographic/videos to be taken of my child during activities.
*
I do
I do not
I do / do not
(select as appropriate)
consent
for photographic/video footage of my child to be used for promotional purposes.
*
I do
I do not
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