Inspire: leadership through sport

PARTICIPANT FIRST NAME

PARTICIPANT LAST NAME

DATE OF BIRTH

Date

GENDER

NATIONALITY

HOW WOULD YOU DESCRIBE ETHNIC ORIGIN*?

*We are required to collect data on ethnic origin as part of our commitment to Sport England Clubmark

ADDRESS (IN FULL)

POSTCODE

PARENTS/CARERS NAME(S)

TELEPHONE

Format: (00000) 000000.

MOBILE

Format: 00000 000000.

EMAIL

example@example.com

ALTERNATIVE EMERGENCY CONTACT (Name, mobile and telephone number)

DETAILS OF ANY RELEVANT MEDICAL CONDITIONS

PARTICIPANT SCHOOL ATTENDED:

Option 1: Tuesday 19 JulyOption 2: Tuesday 2 August

Option 1: Wednesday 20 JulyOption 2: Wednesday 3 August

Option 1: Tuesday 26 JulyOption 2: Tuesday 9 August

Option 1: Wednesday 27 JulyOption 2: Wednesday 10 August

Option 1: Tuesday 30 AugustOption 2: Wednesday 31 August

I undertake to notify the organisers as soon as possible in the unlikely event of the participant not being able to attend all or any of the sessionsI accept that I may be liable for reimbursement of expenses (limited to £20 per session) for any day not attended (unless due to illness) without 2 weeks prior noticeI acknowledge that both Weald Coaching Limited and Small Acts of Kindness have a Data Privacy Policy and the information on this form will be processed in accordance with those policiesI consent to my email and mobile details being uploaded on Teamer software to confirm the participant's availability and attendanceI agree that Weald Coaching Limited, Small Acts of Kindness and Staplehurst Cricket & Tennis Club do not accept responsibility or liability for any personal accident or injuries incurred during any of its activitiesThe participant will read Weald Coaching's Code of Conduct and agree to abide by itI consent to photography of the participant in games and training and appropriate use of photographs in Weald Coaching Limited and Small Acts of Kindness publications and website

*This may affect the participant's ability to take part

SIGNED (PARENT/CARER)

DATE

Date

Inspire: leadership through sport

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