Chester FC PAN-Disability Football Registration & Consent Form

1
Participant Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.
Date
Day
Month
Year
3
Emergency Contact Name* This field is required.
First Name
Last Name
4
Emergency Contact Phone* This field is required.
Mobile Number
5
Email* This field is required.
example@example.com
6
Medical InformationPlease give details of any allergies, medical conditions, medication requirements, dietary needs, access needs or other relevant information.
7
Do you give consent for the named participant to be included in photography and filming while taking part in our activities?* This field is required.
Yes
No
8
Do you give consent for images of the named participant to be used to celebrate and promote our activities through our website, marketing material and social media?* This field is required.
Yes
No
9
First Aid & Assistance

In the unfortunate event of accident or injury, we need your consent to adminster first aid. All coaches have completed Emergency First Aid training.

In addition, there may be occasions where younger children require assistance with clothing or shoes and again we need your consent for coaches to provide this.
10
Do you give consent for the named participant to receive first aid treatment and assistance if required?* This field is required.
Yes
No
11
Booking Terms & Conditions

Refunds: Please note refunds will not be issued due to bad weather. We are unable to credit or refund due to illness unless special circumstances.

Accident & Injury: By registering to attend Chester FC Community Trust sessions, I give consent for the above named participant to take part in physical activities and accept that on rare occasions accidents and injuries may occur. Chester FC or Chester FC Community Trust can accept no liability for accidental injuries sustained by participants during our sessions.
Should be Empty: