Participant Information Form

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Sunnah Sports Academy Trust (2022)

Participant first name. *

Participant surname. *

Participant D.O.B. *

YYYY

Participant age. *

CHILD VIDEO/PHOTO CONSENT. I give Sunnah Sports Academy Trust (SSAT) permission to take photographs and/or video of my child. I grant SSAT full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve SSAT’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications. *

Yes

Participant gender *

Ethnic background. *

African

British Bangladeshi

British

Carribean

Chinese

English

Gypsy

Irish

British Indian

British Pakistani

Scottish

Traveller

Welsh

Mixed/Other

Preferred not to say

Black or Black British

Religion *

Buddhism

Christianity

Hinduism

Islam

Sikhism

Jewish

No religion affiliation or belief

Prefer not to say

Participant contact number *

Participant postcode. (Please use capital letters) *

Does participant consider themselves to have a disability? If yes, please provide details *

Does participant consider themselves to have a learning difficulty? *

Yes

Required

Does the participant have a medical condition? If yes, please provide details *

Is participant recovering from a serious illness or surgery? If yes, provide details. *

Is participant taking any form of prescribed drugs or medication? If yes please provide details. *

Does participant have or ever had high blood pressure? *

Yes

Does participant have epilepsy? *

Yes

Does participant suffer from any lung conditions or has done in the past? (Asthma, bronchitis etc) *

Yes

Does participant often feel faint or have dizzy spells? If yes, please provide details. *

Does participant suffer from any orthopaedic conditions, joint pain or back problems? If yes please provide details. *

Does participant have any allergies? If yes please provide details. *

Emergency contact: full name. *

Emergency contact: relationship to participant. *

Emergency contact: contact number (1) *

Emergency contact: contact number (2) *

HOW WE USE YOUR INFORMATION: To comply with the current laws, we must tell you how we use this data and ask for your permission. We will need to collect and record your personal information to be able to keep you and Sunnah Sport Academy Trust (SSAT) staff safe during our sessions. We may also use the data for statistical purposes, without identifying anyone to meet funding requirements.The record of data will be stored electronically and accessed by relevant staff employed by SSAT. Paper records of your data will also be kept and will be stored securely onsite by SSAT. By signing this form, you are providing your permission for us to use your data for the purposes described here and you are confirming that the information provided above is correct. If any of the details change it is your responsibility to let SSAT know immediately.We will not record your information unless you provide your consent. However, this may impact on our ability to offer services to you. *

Yes - I give my consent to SSAT recording sensitive personal information about me. (Data is used for internal use only unless we notify you otherwise).

No – I do not give my consent to SSAT recording sensitive personal information about me. (If you select this option you will be required to complete this form on each occasion).

If you selected 'NO' to the previous question your data will be deleted immediately and you will be asked to complete this form every single time you or your child attend a session. If you wish to revise your answer please do so now. *

OK, I have changed my answer.

I choose to complete this form every time I attend a session.

ARCHERY WAIVER: Please click on the following link and read the archery waiver even if you are not enrolling for this sport at this time. https://sunnahsportsacademytrust.com/useful-links *

I have read the archery waiver statement and I accept the terms.

Signed by (full name): *

Signature (must be a parent/guardian for people under 16): *

Today's date: *

YYYY

If for any reason you wish to revoke consent, please contact: admin@sunnahsportsacademytrust.com *

OK I undertand.

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