20:20 Foundation Trip Registration Form

20:20 Foundation Trip Registration Form
20:20 Foundation requires everyone to register for the community trips. This is a requirement by law and you will also be covered by our public liability insurance

Please register below and select relevant answers . If you have any questions, please call 07395 557606 or email neighbourhood.matters@gmail.com
Person Contact Information

Every Participant will need this form fill in for each trip
Name*

First NameLast Name
Destination & date *
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

City

Post CodeCountry
GP Contact Information

Every Participant will need this part of the form in
GP / Doctors Name*

Full name
GP’s / Doctors Phone Number*

Area CodePhone Number
GP / Doctors Address*

Street Address

Street Address Line 2

City

Post CodeCountry
Emergency Contact Information

Every Participant will need to share this information in case of en emergancy
Emergancy Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact relationship to particiant?*
Emergency Contact Persons Address*

Street Address

Street Address Line 2

City

Post CodeCountry
Terms & Agreement
- Kindly make sure that the participants on this trip have the necessary tools and equipment to attend this trip .
- The Coach will leave at the specified time with or without the participants both leaving home and on the return Journey.
- you will need to have made full payment information within 24-48 hours after completing this form. Please take note that we are all volounteers.
- For cancellation, please speak directly to your contact and send an email 21 days before the scheduled date. If the cancellation is made below 21 days, a cancellation fee will be charged. Cancellation made 14 days before the event will not be refunded.
- By completing this form, you understand that you are required to follow the rules and regulations of 20:20 Foundation Trust during the trip.
- Informed Consent & Acknowledgement (Child & Adult)
- I hereby give my approval for mine / my child’s participation ( if this is a childs consent form ) in any and all activities prepared by 20:20 Foundation Trust during the selected trip. In exchange for the acceptance of said mine / my child’s candidacy by 20:20 Foundation Trust, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless 20:20 Foundation Trust . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected field Trip.
- In case of injury to said child / me, I hereby waive all claims against {Organisation} . including all coaches, Staff, Volounteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
- Medical Release and Authorisation for young person
  
  As Parent and/or Guardian of the named participant , I hereby authorise the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
  
  Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorisation is granted only after a reasonable effort has been made to reach me.
  
  Permission is also granted to the 20:20 Foundation Trust and its affiliates including Directors, Coaches, Staff and Team Parents to provide the needed emergency treatment prior to the particitpant / child’s admission to the medical facility.
  
  Release authorised on the dates and/or duration of the registered season.
  
  This release is authorised and executed of my own free will, with the sole purpose of authorising medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
  Photograph Authorisation and permission
- I give permission for my child / me to be photographed for magazines, newsletters, publicity materials and/or website whilst he/ she / we are participating in activities provided by 20:20 foundation Trust. I have read the information supplied and agree to my child taking full part in the above. I agree to the above named person receiving emergency medical treatment, including anaesthetic, as considered necessary by the medical authorities present. I understand the need for my child to obey all reasonable instructions from staff/volunteers, and that whilst every care will be taken by the staff/volunteers, they cannot be held responsible for any accident or incident arising out of the unreasonable behaviour of the above named or any third party. By disagreeing we may not be able to accommodate your child into our activities, due to the nature of evidence for parents who request visual feedback and social media platforms we use.
  Confirmation
- BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Registrant Signature

Clear
Date Signed*

DayMonthYear
Date
Should be Empty:

20:20 Foundation Trip Registration Form

Person Contact Information

GP Contact Information

Emergency Contact Information

Terms & Agreement

Informed Consent & Acknowledgement (Child & Adult)