Sport Academy Registration Form

1

Child's Name* This field is required.

Name

Last Name

2

Birth Date* This field is required.

3

Gender* This field is required.

Male

Female

Prefer not to say

4

Ethnic Group* This field is required.

5

Address* This field is required.

Street Address

Borough

Post Code

Country

6

School & School Year* This field is required.

7

Name* This field is required.

First Name

Last Name

8

Email* This field is required.

ejemplo@ejemplo.com

9

Phone Number* This field is required.

07564 001100

10

Emergency Contact's Name* This field is required.

First Name

Last Name

11

Relationship* This field is required.

12

Phone Number* This field is required.

07564 001100

13

Does the child have any allergies, chronic illness, or medical conditions?* This field is required.

Yes

No

14

If yes, please describe.* This field is required.

15

Does the child requires SEND support?* This field is required.

Yes

No

16

If yes, please describe.* This field is required.

17

Free Leave Authorization* This field is required.

Yes, I authorize my child, over 9 years, to walk home or other specified destination, on their own after the activities. I have explained to my child the safety aspects of walking home on their own.I understand that it is the responsibility of parents, and not UK Latin Community and its affiliates including Directors, Coaches, and Team Parents, once my child has left the venue premises.

No

18

Photo Release & Authorization* This field is required.

Yes, I give my consent to the organization UK Latin Community to take photographs and / or video of the named child. Full rights are granted to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes in order to help UK Latin Community achieve the organization’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications.

No

19

Medical Release & Authorization* This field is required.

Yes, I authorize 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. Permission is also granted to the UK Latin Community and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

No

20

Data Sharing Authorization* This field is required.

Yes, I authorize the organization UK Latin Community to share & validate the data collected on this form with relevant third parties such as local authorities, NHS, medical centres, among others, if necessary.

No

21

Newsletter suscription* This field is required.

Yes, I would like to receive advertising mailing about upcoming events and activities from UK Latin Community CIC.

No

22

Is there any additional information we should know? Please describe.

23

Thank you for completing this registration form! Remember that we have a £3 fee per person per day in order to cover part of the costs of this community service.