Participant Consent Form

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This form is both the Consent Form & Registration for Community Development Programmes.

Option 1

Clear selection

Participant Name *

What programme are you signing up for? *

Date of Birth *

YYYY

Participant Age *

Address (please include full address) *

Postcode *

Participant Email Address *

Personal Contact Number *

Gender *

Female

Male

Prefer not to say

Other:

Ethnicity *

White or White British

Black or Black British

Asian or Asian British

Chinese or other

Mixed

Prefer not to say

Other:

Religion *

Buddhist

Christian (including Church of England, Catholic, Protestant, all other Christian denominations)

Hindu

Jewish

Muslim

Sikh

No religion

Prefer not to say

Other:

Emergency Contact details (this cannot be left blank or be yourself) *

Do you/ does your child have any specific medical needs/additional needs/disabilities/mental health issues/long-term health conditions that we need to be made aware of? *

Yes

If you answered yes above, please specify

The foundation will from time to time use photographs or videos taken during our courses on social media for promotional purposes, please state whether you consent to the use of any photographs or videos being on social media *

Yes

Required

Please state if you agree to the foundation contacting you about our programme(s) via email or social media *

Yes

I give permission for myself/child to receive first aid for any injuries sustained during the session *

Yes

I acknowledge that Crawley Town FC Foundation staff are only responsible for participants whilst attending CT Foundation courses and cannot be held responsible for their welfare once they have left the site. *

Yes

I agree to the information above and can confirm I have provided the correct information where necessary. *

I agree

I disagree

Required

Any other comments?

Once you complete this form, you will be fully signed up. Please ensure your child is equipped with a water bottle and appropriate clothing/footwear for the session. No confirmation will be sent to you, see you at the session *

I agree

Required

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