Adventure Academy Camp Sign-Up

Registration of Interest - Exclusive to PossAbilities Members

After School Camp - Monday to Friday (After School Camp will run regardless of inservices within school time - 1530hrs to 1800hrs - gates to open at 1515hrs for drop-off) is excluvie to paying PossAbilities members. Please ensure you have signed up or renewed your membership on the GloFox app. After School Camp will require week to week sign up to allow application access for all to sign up and positions will be upon application with placements to be determined by PossAbilities due to limited capacity. Thanks!
Attendee details
Full Name*

First NameLast Name
Preferred name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal Code
YesNo

Date of Birth of attendee

DayMonthYear
Date
Early Birds 0-5 yearsMini Buddies 6-10 yearsBuddies 11-15 yearsFocus 16+ years
Attendee diagnosis / pending diagnosis / Specific needs
What triggers or dislikes does the attendee have that we should be aware of?
How can we best support the attendee?
What likes or motivators does the attendee have that we should be aware of?
What toileting requirements does the attendee have, if any?
Medical requirements or ALLERGIES
Mobility requirements
Photograph of attendee

Cancelof
Please upload any images / PECS that may support the attendee

Cancelof
Attendee communication - Please detail the spoken / understood languages or communication methods used by the attendee
Please use this space to inform us of any further information which will help staff to work along side the attendee i.e. useful information, advice for particular situations, particular routines, etc...

Emergency Contacts - Persons to contact in case of an emergency

Rows	Full Name	Relation	Contact Number	Address
1
2
3

Email
example@example.com
Mobile number
I hereby agree and declare that I am the legal parent guardian (and have permissions as such) of the above-named attendee (“the attendee”) and hereby consent to the attendee's participation in PossAbilities After-School Camp ("camp") and hereby agree and declare that I understand the scope of the sessions. I understand that some of the activities to be undertaken during the sessions may be of the kind which may result in, however unlikely, physical injury to the attendee but nonetheless specifically request that they be allowed to participate in said sessions.

If the attendee requires any first aid, non-emergency or emergency medical treatment or procedures during the sessions, I hereby consent to PossAbilities Limited’s staff to make any decision and take any action necessary to arrange for such procedures or treatments at the discretion of sessions staff and acknowledge that PossAbilities Limited will make all reasonable attempts to contact me but if this is not possible, I confirm that PossAbilities Limited is authorised to act on our behalf to make any necessary first aid, non-emergency or emergency medical treatment / decision.

In consideration of my application and permitting the attendee to participate in the sessions, I hereby agree to WAIVE, RELEASE, AND DISCHARGE PossAbilities Limited and its directors, officers and employees from any cause of action, claims or demands now or in the future and from any and all liability arising from or in connection with the sessions for any injury or consequence, property damage, property theft, property loss or actions of any kind which may occur to the attendee during the sessions, including during any activities.

I hereby agree for the attendee's data to be held in line with data protection laws and regulations, as per PossAbilities policies. I agree that the attendees progress and details may be discussed with professionals and consultants, in relation to their particiaption of camp, always in the best interest of the child attending.

I hereby agree to commit to payment of the full week being applied for at the rate of £50 per calendar week. Any payments made will be non-refundable unless agreed to by PossAbilities management.

I acknowledge and accept, in the event of reoccurring late collections from Camp, I may face a penalty or surcharge.
I consent to the attendee participating in all off-site activities including traveling in PossAbilities organised transportI consent to PossAbilities to allow its staff and any agents to take photographs and videos of my child and give permission for said Photos and videos to be used by PossAbilities in connection with any publicity material including publishing of said content, photos and videos on PossAbilities'social media platforms and for any other PossAbilities Charity marketing purposesI consent to the application of the attendee's own sun cream or alternatively to the use and application of sun cream provided by PossAbilities if the attendee does not bring their own (only if required)In the event snacks are not packed for the attendee, I consent and give permission to PossAbilities' staff to give the attendee any snacks supplied by PossAbilities (in line with their dietary requirements (if any)
By signing below, you are signing that you confirm you are or are a legal guardian signing on behalf of, the attendee.
Name of Person completing application

First NameLast Name
Should be Empty:

Registration of Interest - Exclusive to PossAbilities Members