APRIL SCHEME REGISTRATION FORM
Dates
Time
Venue
7th to 10th April
2:00 PM to 5:00 PM
CYCD, 94 - 106 Leagrave Road, Luton, Beds, LU4 8HZ
Please complete this form in full. Demographic questions such as ethnicity are optional and should only be used for inclusion monitoring and safeguarding purposes.
1. Child details
Child's first name
*
Child's surname
Date of birth
*
-
Day
-
Month
Year
Date
Age
School
Home address
Postcode
Ethnicity (optional)
White
Black / African / Caribbean
Asian / Asian British
Mixed / multiple ethnic groups
Other ethnic group
Prefer not to say
If 'other', please describe (optional)
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2. Parent / guardian details
Parent / guardian
*
Relationship to child
Mobile number
*
Email address
Relationship to child
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3. Attendance and collection arrangements
Days attending
Day 1
Day 2
Day 3
Day 4
Main activities / interests
Martial arts
Arts and crafts
Computing
Outdoor sports
Museum trip
My child has permission to walk home alone at the end of the session.
Yes
No
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4. Medical, wellbeing and support needs
*
My child has any medical condition, allergy or additional need that staff should know about.
My child carries medication that may need to be used during the scheme.
I consent to basic first aid being given if required.
In an emergency, I authorise staff to seek urgent medical treatment for my child.
I give permission for my child to participate in martial arts activities and acknowledge the normal risks of physical activity.
Please list any medical conditions, allergies, dietary requirements, SEND / accessibility needs, behaviour support information, medication instructions or triggers staff should be aware of.
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5. Permissions and declarations
5. Permissions and declarations
*
I consent to my child taking part in the trip / off-site visit included in the April Scheme.
I consent to photographs / videos of my child being taken for internal records and programme promotion.
I understand that I must inform the organisers of any change in my child's details, medical needs or collection arrangements.
I confirm that the information on this form is accurate and complete to the best of my knowledge
Photo / media restrictions, trip notes or anything else you would like staff to know.
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6. Emergency contact if parent / guardian cannot be reached
Emergency contact name
Relationship to child
Primary phone number
Format: 00000000000.
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Date
-
Month
-
Day
Year
Date
Signature
Retention note: keep this form securely and only collect personal information that you genuinely need.
Submit
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