Hackney Christmas Activities 2021
Please complete this form if you wish to attend our free of charge Christmas holiday activity programmes for young people aged 8 to 16
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Email *
Please select the activities you want to take part in. Please do not sign up to two or more events that take place at the same day and time.
At the end of the sessions my child will: *
Shoe size (if you want to attend roller-skating) *
Which, if any, Access to Sports session does your child currently attend during the school term *
First name (of young person participating) *
Last name (of young person participating) *
Gender *
Ethnicity of participant *
DOB of participant (please do not select the current year) *
MM
/
DD
/
YYYY
Address *
Postcode *
Emergency contact number *
School that participant attends *
Are you eligible for free school meals? *
How much notice do you require should a space become available (we sometimes get drop outs on the day) *
Do you / does your child have a disability or statement of ‘Special Educational Needs’? *
If yes please give details
Do you / does your child have any conditions requiring medical treatment, including any medication you will need access to on a regular basis while attending? *
If yes please give details
Do you / does your child take any medication for asthma? *
If yes please give details
Does your child have any allergies including food allergies? *
Required
If yes please give details
Any other relevant information? (medication, diet, behaviour etc)
Medical Consent *
It may be essential from time to time for staff to have the necessary authority to obtain any urgent treatment which may be required by the participant whilst at The Access to Sports Project’s activities. I therefore acknowledge the following: Myself / my child is in good health and in my opinion capable of taking part in The Access to Sports Project activities. I have completed the medical details consent that in the event of any illness / accident any necessary treatment can be administered to my child, which may include the use of anesthetics. I also understand while staff will take every precaution to ensure that accidents do not occur, they cannot necessarily be held responsible for any loss, damage or injury incurred.
Required
Certain activities may involve participants being photographed or filmed for promotional use for our printed and online publicity, social media and/or press releases. Please indicate if you consent to your child being filmed and/or photographed. *
Required
Referral organisation (if applicable)
Staying in touch: We’d like to send you updates and information on our upcoming programmes. Please tick to indicate your preference: *
Required
Research, Monitoring and Evaluation: *
We may undertake research questionnaires, monitoring and evaluation exercises involving both children and adults to measure the effectiveness of our work. Involvement in these activities will be purely voluntary and participants can pull out of the research at any time.
Required
Data Protection *
We take your privacy seriously and ensure that your information is handled safely and securely and in line with current data protection regulations. Copies of our full privacy notice are available on the website or can be requested from the Access to Sports office. As part of our work we are required to hold personal information on participants. We do this to ensure that participants are safe and protected whilst at Access to Sports and to ensure the effectiveness of our charitable work.
Required
I give consent to the participant attending the project and agree to the following: Sports and physical activity is undertaken at your own risk. If you have any concerns about your health or suitability for the chosen activity you should seek guidance from a doctor or health professional before participating. Do not come to the centre or venue if you are unwell, have any Covid symptoms or have been told to self-isolate.
Parental Consent: Please type full name
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