Get Involved registration form The Core at Corby Cube

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If the participant is aged 18 or under, a parent or guardian will need to fill in this form.

Which group is this for?

Sparks 5-7

Sparks 8-11

Core Create 12+

Core Comedians 12+

Clear selection

Participant name

Participant address

Date of birth

YYYY

Age

School or college attended

Email address (parent or guardian email if participant is aged 18 or under)

Parent/guardian name

Emergency contact number

Additional emergency contact (name and phone number)

Any medical, health or support needs you would like to make us aware of

Please tick the following boxes to agree and give permissions: *

I understand that for under 18s to take part in online sessions with The Core, there must be a parent/guardian in the same room or room next door with the door open throughout the session.

I will ensure that adequate space is cleared for activity to safely take place at home.

I will inform The Core if my son/daughter is unwell or unable to take part in a session.

I give permission for my child to be filmed and photographed for the termly showcase event and for this film to be shared publicly/on social media/The Core website for a limited time. Photographs may appear on The Core's website, social media or in the brochure

I understand that the camera must be kept on at all times throughout an online session

Required

I confirm to agree to the following (please read carefully and tick all boxes to give consent):

I confirm that I/my child will not attend a session if: I/They are displaying any symptoms of Coronavirus, I/They have had a positive Covid test in the proceeding 10 days, I/They should be self-isolating either due to notification by NHS test and trace or due to a household member, support bubble member or close contact having symptoms or a positive test in the proceeding 10 days

I consent for my/my child’s details to be collected and if required passed on to NHS Test and Trace

I confirm that the named emergency contact will be available throughout the duration of any session to collect the participant should they become ill or symptomatic of Coronavirus during the session

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms