Ice Skating Event Consent & Registration Form

Potential Unlocked: Ice Skate Birmingham – Consent & Registration Form
Ice Skate Birmingham

📅 Saturday 7th December | 5:00 PM - 7:30 PM
📍 Centenary Square, Broad Street, B1 2ND

Get ready for an unforgettable evening of fun, excitement, and forging powerful friendships with peers who are on the same journey to unlock their full potential! At Potential Unlocked, we are all about helping your child achieve the grades they deserve while nurturing their God-given talents for greatness. This is more than just a game—it's an opportunity to build a community of high achievers who are determined to live a fulfilled, successful, and transformed life!

🎯 What’s Included?
- entry to Ice Skate Birmingham, a 45 minute session on the ice and boot hire—completely on us!
- A post-game treat at McDonald's—our way of saying "well done!"

And here's the best part: your child can invite a friend from school to join the fun, and we’ll cover their costs too!

All we ask is for a refundable deposit of £30.00 by Saturday 30th November 2024, to secure your child’s place and there guest. The deposit will be refunded back to your debit/credit card on Thursday 12th November 2024. Don’t miss out on this incredible chance to encourage friendships, inspire greatness, and have a blast while doing it!

🚀 So, what are you waiting for?
To secure your child’s spot, simply fill out the form below. If you have any questions, feel free to contact us at 0121 405 0853.

Let’s unlock potential together!
Parent/Guardian Information
Full Name of Parent/Guardian*

Parent First NameParent Last Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Student Information
Full Name of Student*

First NameLast Name
Age of Student*
Friend Invite Information
Full Name of Friend*

First NameLast Name
Friend's Parent/Guardian Full Name*

First NameLast Name
Guardian’s Email Address*
example@example.com
Guardian Phone Number*
Please enter a valid phone number.
Medical Information
Does your child have any allergies or medical conditions?

YesNo
If Yes, Please specify allergies/medical conditions*
Emergency Contact Information*
Please enter a valid phone number.
Your Child’s and Guest’s Meal Selection

Please select the meal you would like to order for your child and their guest. Kindly note that no changes can be made once the order has been submitted through this form.
McDonald's Meal Choice for Student*
McDonald's Drink Choice for Student*
McDonald's Meal Choice for Guest*
McDonald's Drink Choice for Guest*
Event Consent
I, First Name Last Name, give my consent for my child Student’s Name, to attend Ice Skate Birmingham.

Please read and confirm your understanding of the following terms:
1. Participation Liability: I understand that my child’s participation in this event is voluntary, and I accept full responsibility for any personal risks involved.
2. Transportation: I acknowledge that I am responsible for arranging my child’s transportation to and from the venue.
3. Refund Policy: I agree that the deposit is non-refundable.
4. Supervision: I consent to my child being supervised by the organisers during the event, ensuring their safety and well-being.
5. Medical Consent: In the event of an emergency, I authorise the organisers to seek necessary medical attention for my child.
6. Media Release: I grant permission for my child’s photos or videos to be taken and used for event promotional purposes.
Parental Consent*

Yes, I have read and understood the above terms and conditions, and I agree to them.
Payment Details
Waiver of Liability
I First Name Last Name , release Potential Unlocked from any and all liability in connection with my child’s participation in the Ice Skate Birmingham event. I confirm that my child is in good health and capable of participating in physical activities.

blank
Liability Waiver Agreement*

I agree to the terms and conditions of the Liability Waiver.
E-Signature Consent
Electronic Signature Consent*

By signing below, I understand and agree to the terms of this consent form and confirm that the information provided is accurate.
Guardian’s Full Name*

First NameLast Name
Date of Signature*

DayMonthYear
Date
E-Signature*

Powered by Jotform SignClear

Payment Terminal*

Card Terminal The refundable deposit covers both your child and their guest and will be returned after attending the event.

£30.00 Quantity

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Potential Unlocked: Ice Skate Birmingham – Consent & Registration Form

Parent/Guardian Information

Student Information

Friend Invite Information

Medical Information

Your Child’s and Guest’s Meal Selection

Event Consent

Payment Details

Waiver of Liability

E-Signature Consent