Hoopz

Access Sport Hoopz

Shooters Hill Sixth Form College,Red Lion Lane, London SE18 4LD
A disability-inclusive basketball session for 16+ years is designed to create an empowering and supportive environment that promotes participation, skill development, and teamwork among all players, regardless of their abilities

SESSIONS BEGIN FRIDAY 26th September

Fridays 2pm - 3pm

As part of the funding that allows us to support this activity, we are required to gather this information to help analyse our impact. It also helps coaches to provide high quality sessions with suitable support.

We will always store your personal details securely. We’ll use them to provide the service that you have requested and communicate with you in the way(s) that you have agreed to.

For full details see our GDPR Policy: https://www.accesssport.org.uk/gdpr
Childs Name:

First NameLast Name
Date of Birth *

MonthDayYear
What gender do you identify as?*
Email
example@example.com
Participant Ethnic Origin:*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Post code .
PARENT/GUARDIAN INFORMATION
Parent/Guardian*

First NameLast Name
Mobile Number:*
E-mail address*
example@example.com
EMERGENCY INFORMATION
Emergency Contact's Name*

First NameLast Name
Mobile Number:*
Does the participant have difficulty with any of the following areas? (please tick all that apply)*

NoneMoving around including walking and runningUsing your hands for writing or to pick things upSeeing and using your eyesHearing and using your earsSpeaking and communicatingBreathing (for example asthma)Difficulty learning new thingsAttention differences (for example ADHD)Social and or communication differences (such as autism)Reading or writing (for example dyslexia)Using numbers (for example dyscalculia)Co-ordination (for example dyspraxiaYour mental health and how you feelRegular Pain and discomfortLiving with a long-term health conditionPrefer not to say
In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise, and brisk walking or cycling for recreation or to get to and from places. Include physical activity in and out of school/college and as part of your job etc.*

01234567
In the past week, on how many days have you done a total of 60 minutes or more of physical activity, which was enough to raise your breathing rate?*

01234567
Media/ Photo ConsentI give permission for images/footage to be taken of me whilst taking part. I understand that the images/footage may be used to promote the work of Access Sport and the partner club, for example on our website, social media or in authorised publications*

I give permission as the parent/carer/guardian (under 18 only)I give permission as the participant (over 18 only)
SESSION DATES*

26th September3rd October10th October17th October24th October7th November14th November28th November5th December12th December
If you would like to sign up to the Access Sport Newsletter for updates on the latest inclusive sport and physical activity opportunities, then please provide your email address.
example@example.com
Should be Empty:

Access Sport Hoopz