Haberdashers - Multi Sports and Mentoring Program

Dynamic Coaching, Multi-Sports and Mentoring Program

All Saints Church, 107 New Cross Road, London, SE14 5FF
Dynamic Coaching – Multi-Sports and Mentoring Programme

Dynamic Coaching delivers an engaging and inclusive Multi-Sports and Mentoring Programme designed to support and inspire young people through a blend of physical activity and personal development. Funded by Haberdashers’ Foundation.

Time: 3.30pm - 4.30pm
VENUE:
Childs Name:

First NameLast Name
Date of Birth

DayMonthYear
Gender:
School Year Group:
Name of School:
Primary or Secondary School:
Ethnicity:
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:
Relationship
Does your child / young person have an Education and Health Care Plan at school?
MEDICAL INFORMATION
Does your child/young person have any Special Educational needs and/or disabilities - Please note this camp is not a SEND camp and we will not be able to offer 1-1 support.
If yes, please specify to ensure we can provide the support your child needs:
Does your child have any type of allergy including food allergies, a chronic illness/disability or have any other medical conditions?
If yes - please inform us what the allergy is and what to look out for eg, early signs of a reaction and how severe the allergy is, please also let us know about any chronic illness:
Does your child carry an Epi pen?
If yes do you give permission for one of the coaches to administer an EpiPen if needed?
Do you give consent for Dynamic Coaching to use your child's photograph or video on websites/social media channels
In order for Dynamic Coaching to comply with privacy regulations, we will need you to give consent to enable us to contact you regarding our free camps via the information provided in this form;
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PLEASE BOOK YOUR SESSION HERE - ALL SESSIONS ARE FREE
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Dynamic Coaching, Multi-Sports and Mentoring Program