Parent/Carer Referral Form - Boxing Camp

Referral Form

Please fill out the information below:

Referral date

Please read the information carefully, should you have any queries, please contact info@n3wangle.com

Young persons details:

Young person’s full name

Date of birth

Home address

What school does the young person attend?

What year group are they in?

Do you need to share any additional information?

Boxing Camp Sessions

Location: MBMT, Unit 4 Bridgewater Cl, Reading RG30 1JT

For School Years 7 - 9

Time: 11am - 1pm

Select the dates you'd like to book:

Monday 17th February - Wednesday 19th February - Friday 21st Febraury: 11am - 1pm

All DaysMondayWednesdayFriday

For School Years 10+ and School Leavers

Time: 1pm - 3pm

Select the dates you'd like to book:

Monday 17th February - Wednesday 17th February - Friday 21st Febraury: 1pm - 3pm

All DaysMondayWednesdayFriday

Parent/Carer contact details:

Your full name

Your phone number

Your email address

Relationship to the young person

Emergency contact details:

Full name

Phone number

Email address

Relationship to the young person

Collector contact details:

Full name

Phone number

Email address

Relationship to the young person

Doctor contact details:

Doctor

Surgery

Phone number

Young persons information:

Does your child have any dietary needs?

YesNo

If yes, please give details:

We do not allow nuts or nut products in any of our settings

Does your child have any allergies?

YesNo

If yes, please give details:

Does your child have any medical conditions?

YesNo

If yes, please give details:

Does your child take any medication?

YesNo

If yes, please give details:

Does your child have an auto-injector?

YesNo

If yes, please give details:

Does your child have any Special Educational Needs?

YesNo

If yes, please give details:

Young persons consents:

I consent to my young person being filmed or photographed to be used for advertising

YesNo

I consent for pictures or videos of my young person to be used on social media

YesNo

I consent to my young person taking part in supervised controlled sparring*

YesNo

I consent to my young person going home alone

YesNo

I consent to my young person receiving basic first-aid treatments

YesNo

I give N3W ANGLE consent to administer Paracetamol to my young person.

YesNo

*bring headguard, gumshields and gloves if owned.

Thank you for taking the time to complete this form. By signing you are confirming your permission in relation to the above information and your child whilst attending a N3W ANGLE setting.

Any queries, please contact info@n3wangle.com

Contact Signature