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

MOBILE

EMAIL

example@example.com

ALTERNATIVE EMERGENCY CONTACT (Name, mobile and telephone number)

DETAILS OF ANY RELEVANT MEDICAL CONDITIONS

PARTICIPANT SCHOOL ATTENDED:

DAY 1

Option 1: Tuesday 19 July Option 2: Tuesday 2 August

DAY 2

Option 1: Wednesday 20 July Option 2: Wednesday 3 August

DAY 3

Option 1: Tuesday 26 July Option 2: Tuesday 9 August

DAY 4

Option 1: Wednesday 27 July Option 2: Wednesday 10 August

DAY 5

Option 1: Tuesday 30 August Option 2: Wednesday 31 August

I confirm that (please tick the box if you do NOT accept the condition*):

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 sessions I 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 notice I 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 policies I consent to my email and mobile details being uploaded on Teamer software to confirm the participant's availability and attendance I 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 activities The participant will read Weald Coaching's Code of Conduct and agree to abide by it I 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)

Clear

DATE

Date

Inspire: leadership through sport

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