Rebound and Regulate SEND sessions

Rebound and Regulate SEND sessions

Please use this form to book a place for your child on our ‘Rebound and Regulate’ workshop, starting 20th September 2024.
The workshop will run for 6 weeks and is aimed at children aged 5-14 who find community sports sessions difficult to participate in due to sensory sensitivities, coordination difficulties, anxiety, reduced confidence, difficulty following instructions and/or struggle to focus.

Once you have submitted the form, you will be contacted by Chris from Portsmouth Force Basketball Club within the next 3 working days to arrange payment.
Guardian / Parents / Carer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City/TownCounty

Post code
Mobile Phone*
E-mail*
example@example.com

Player details
Player name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Gender*
School year*
Educational setting*
If you selected "other", please tell us more
Please provide any relevant medical information about your child, including past and current medical history, medications or other health considerations:*
To enable us to cater for your child’s needs effectively, please provide plenty of detail about your child’s additional needs including sensory issues, learning needs, physical skills, communication needs and any other relevant information.*
Please explain what you hope your child will gain from attending the 6-week workshop.*
Confidentiality: I understand that the information shared through completion of this form will be kept confidential, except where required by law.*

I understand
Health and Safety: I agree to stay onsite during the workshop sessions and maintain responsibility for my child’s medical and health needs.*

I understand
Photo/Video permissions*

Yes, the club may take photos/videos and use for promotional purposesNo, please do not use photos to promote the club
By submitting the form, we will contact you regarding your sign up request via email or phone. For additional updates on future offer, are you happy for us to contact you?*

Yes, I agree to receive marketing communication for Portsmouth Force / The Southsea OTNo, please do not contact me for other than essential updates
I consent to my data being stored and processed by Portsmouth Basketball Club for use in their management system which helps to organise the playing and enjoyment of sport for its members.*

I agree
I agree to the Pitchero Terms of Service (https://www.pitchero.com/terms-of-service) and acknowledge my data will be stored, processed and shared by Pitchero in accordance with their Privacy Policy )https://www.pitchero.com/privacy-policy).*

I agree
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