Consent Form for Accerler8 Clinic!

Consent Form For Accerler8 Clinic

A consent form must be completed in order for your child to partake with our services.
1. Participant Details

If, in the event of a medical or other emergency, this is who you should make immediate contact with.
Participant's Full Name

First NameLast Name
Participant's Birth Date

MonthDayYear
Does your child have medical problems?
If Yes, please provide detail's below.
Does your child intend to bring their medication with them on the day?
If Yes, please provide detail's below.
Does your child have any allergies we need to be aware of?
If Yes, please provide detail's below.
Do you consent to emergency first aid being administered if your child suffers an injury?
2. Parent/Guardian Contact

If, in the event of a medical or other emergency, this is who you should make immediate contact with.
Parent/ Guardian Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian's E-mail
Parent/Guardian Phone Number
3. Emergency Contacts

If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
Emergency Contact#1 Name

First NameLast Name
Emergency Contact#1 Phone Number
Relationship
Emergency Contact#2 Name

First NameLast Name
Emergency Contact#2 Phone Number
Relationship
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.
4. Data Protection

Cultiv8 Coaching will collate and store all information in accordance with the Data Protection Act. We use the information that you have given us to ensure the safety and wellbeing of the child only. Your information is securely stored and will never be passed to a third party for marketing purposes.
Do you consent to your email address being used to inform you of upcoming events or information we feel may be of an interest to your child?
5. Photography & Media

We like to share what we do and photograph and video our sessions. This enables us to visually discuss elements of technique and successes. We also like to share publicly what we do and will be posting photos and videos on our social media platforms. If you do not wish for your child to be photographed or videoed, please ensure this information is detailed on this consent form where your written permission is sought. We ask that all parents and guardians who take images at our venues do not share on public media channels unless they have consent from the parent of any other child that may be in the images.
Do you consent to the filming and sharing on social media of your child training?
6.Payment/Policy

When payment is confirmed, the slot will be reserved for your child. Payment must be made in advance of the session. We are unable to guarantee any spaces if we have not received payment in advance. All sessions are non-refundable if your child is unable to attend. If the team have to cancel due to external circumstances, a full refund will be given.
Do you consent to our payment policy stated above?
Date of Attendance
Date of Submitting

MonthDayYear
Signature:
**Note: Consent forms expire 6 months from the date submitted. If information needs to be updated, make immediate contact with Cultiv8 Coaching.
Should be Empty:

Consent Form For Accerler8 Clinic

1. Participant Details

2. Parent/Guardian Contact

3. Emergency Contacts

4. Data Protection

5. Photography & Media

6.Payment/Policy