Healthy Towns Programmes // January 2021 // Youth Archery

Healthy Towns Programmes // January 2021

Participants must be aged between 8 and 17 years to participate in the Healthy Towns programme(s) outlined below
Please note, the submission of an application form for your preferred programme(s) is not confirmation of a programme place. Programme places are limited and will be allocated on a first come, first served basis. Applicants will be sent further information in due course regarding programme selection(s) and whether a place has been successfully allocated.
Section 1

Applicant Information
Name *

First Name Last Name
Gender *
Please select option via drop - down menu
Date of Birth *

Day Month Year
Insert Date
Age (at time of application) *
Please note, applicants must be aged between 8 and 17 years to participate Healthy Towns programme(s) outlined
Address *

Address Line 1

Address Line 2

Town County

Post Code
Phone Number

Area Code Phone Number
Mobile Number *

+44 Number
Email *

Confirmation Email Please confirm your email address
Do you consider yourself to have a disability? *
If yes, please specify the nature of the disability
Section 2

Emergency Contact Information
Emergency Contact Name *

First Name Last Name
Emergency Contact Number *

+44 Number
Section 3

Programme Options, Availability and Selection(s)
Please select preferred programme(s) based upon the programme options outlined and availability.
Youth Archery @ Fermanagh Lakeland Forum, Enniskillen
Youth Archery @ Omagh Leisure Complex
Other Information

> Due to government guidelines, requirements for social distancing and hand sanitising will be required as part of the Healthy Towns programmes;

> Participants whilst attending activity sessions are required to adhere to coach advice and guidance at all times and should only attend if fit and well and have no COVID-19 signs or symptoms or are not isolating etc. as per Government guidelines;

> The archery programme at Fermanagh Lakeland Forum, Enniskillen will operate weekly from the date outlined for 12 - weeks whilst the programme at Omagh Leisure Complex will operate weekly from the date outlined for 6 - weeks;

> The Healthy Towns programmes will be cancelled (indoor sessions) if required as per Government guidance and participants notified accordingly;

> You understand that while participating in activity programmes such as the Healthy Towns programmes, injuries may occur for which coaches are not directly responsible.
Section 4

Medical Information and Declaration
Please select all applicable medical questions (i.e. answered 'yes') below and elaborate on conditions in space provided

Have you ever suffered from blood pressure or any other CV problem? Do you feel pain in your chest when you do physical activity? Are you prone to headaches, fainting or dizziness? Do you suffer from pain or limited movement in any joint? Do you suffer from a bone or joint problem that could be made worse by activity? Do you suffer from diabetes? Do you suffer from asthma? Do you lose balance because of dizziness or do you ever loseconsciousness? Are you recovering from a recent illness or operation? Are you currently taking any medication?
If you selected (i.e. answered 'yes') to any of the questions above please provide further relevant medical information below in the space provided.

If you selected (i.e. answered 'yes') to any of the questions, you should consult your doctor and gain their agreement to undertake physical activity. If your health changes at any time during the programme(s) in relation to the questions above or any other condition, you will cease exercise, inform the coach and consult your doctor. You declare that to the best of your knowledge the information given above (and below) is correct and that you know of no reason why you should not participate in the activity programme(s) selected. You understand that you enter into the programme(s) selected entirely at your own risk and waive any legal recourse for damages which may arise from participation.
Please elaborate and provide any further information regarding medical conditions below. If you have no medical conditions that the coach needs to be aware off please write N/A *
Section 5

Data Protection
In accordance with the Data Protection Act 2018, Fermanagh and Omagh District Council has a duty to protect information we hold on you. The personal information you provide on this form will only be used for the purpose of the programme. Information will be shared with the Public Health Agency (PHA) for the purpose of the programme if required, however, this will not be shared with any other organisations unless law or regulation compels such a disclosure. For further guidance on how we hold your information please visit the Privacy Section on the Council website, https://www.fermanaghomagh.com/your-council/privacy-statement
Section 6

Please complete electronic signature below prior to submission which confirms that the information provided is accurate and correct and understand the requirements outlined in relation to participation within the Healthy Towns programme(s).
Electric Signature

Clear
Please note, the submission of an application form for your preferred programme(s) is not confirmation of a programme place. Programme places are limited and will be allocated on a first come, first served basis. Applicants will be sent further information in due course regarding programme selection(s) and whether a place has been successfully allocated.
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Healthy Towns Programmes // January 2021

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6