Registration, Consent and Health Form (Adult)

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Registration, Consent and Health Form (Adult)

Please provide details in the spaces provided.

All personal information will be held strictly confidential.

Email *

Full Name *

Date Of Birth *

YYYY

Address *

Emergency Contact Name *

Emergency Phone Number *

I consent 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, and I confirm that I am voluntarily participating in these activities with knowledge of the risks.

Yes

Required

I will ensure that I follow the ethos and guidance set by Mini Warriors Ltd - RDDP (Respect / Dedication / Determination & Pride).

Yes

Required

I know of no reason why I 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, I am 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 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 during activities.

I do

I do not

I do / do not (select as appropriate) consent for photographic/video footage to be used for promotional purposes.

I do

I do not

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