Salisbury City Council Participant Registration Form 

  • Salisbury City Council Participant Registration Form

    This form is to register you/your child onto a Salisbury City Council Project. Please fill out one form per participant.

  • Our Sessions*

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        Home Ed PE Sessions, Mondays 10am - 11am Autumn Term min age 6 (sibling discount available)

        Please note there is now a week gap between sessions. Block of 6 sessions 18/11/24, 02/12/24, 16/12/24,

        £24.00£24.00
        Item subtotal:£0.00£0.00
          
        Ability Count Football, Mondays 5pm - 6pm Autumn Term 2024

        Payment for Ability counts football at Salisbury and South Wilts Sports Club 11/11/24, 18/11/24, 25/11/24, 02/12/24, 09/12/24

        £20.00£20.00
          
        Total
        £0.00£0.00
      • Please confirm the amount of participants.*

      • If the sports club you wish to join is unavailable please go to: https://form.jotform.com/BemertonHeath/SCC-ROIF where you can register you interest if a space becomes available.

      • Date of birth*
         - -
      • Does your child need any additional support that may affect them to participate in this activity? for example: illness, disabilities, allergies or additional needs.*
      • Does your child require the routine use of any medication?*
      • Format: 00000000000.
      • Date of birth*
         - -
      • Does your child need any additional support that may affect them to participate in this activity? for example: illness, disabilities, allergies or additional needs.*
      • Does your child require the routine use of any medication?*
      • Format: 00000000000.
      • Date of birth*
         - -
      • Does your child need any additional support that may affect them to participate in this activity? for example: illness, disabilities, allergies or additional needs.*
      • Does your child require the routine use of any medication?*
      • Format: 00000000000.
      • Date of birth*
         - -
      • Does your child need any additional support that may affect them to participate in this activity? for example: illness, disabilities, allergies or additional needs.*
      • Does your child require the routine use of any medication?*
      • Format: 00000000000.
      • Format: 00000000000.

      • Informed Consent and Liability Waiver Release for Participation in Exercise Program

         

        This Agreement is between Holly Hull (Instructor), Salisbury City Council (Facilitator) and the additional Instructors who may be conducting classes and the individual Whose name is signed below (referred to as the participant).

         

        1.       I am participating in Fitness Classes, offered by an instructor during which I will receive information and instruction about the class. I recognise that it requires physical exertion that may be strenuous and may cause physical injury, I am fully aware of the risks and hazards involved and that it is MY RESPONSIBILITY to modify and movements to fit my limitations and level of conditioning.

        2.       I understand that is it my responsibility to consult with a physician prior to and regarding my participation in the Fitness Classes. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Fitness Classes.

        3.       In consideration of being permitted to participate in Fitness Classes, I voluntarily and knowingly agree to assume full responsibility for any risks, injuries or damages, know or unknown, which I might incur as a result of participating in the program and acknowledge my informed consent to do so.

        4.       In further consideration of being permitted to participate in Fitness Classes, I knowingly, voluntarily and expressively waive any claim I may have against the authorized instructor(s) and facilities for damages and injury, including death, resulting from the ordinary negligence of the Instructor, the Facility, its agents and employees, that I may sustain as a result of participating in the Fitness classes.

        5.       I, my heirs, spouse and legal representatives forever release, hold harmless, waive, discharge and covenant not to sue the instructor(s) or facilities for any injury or death caused by my voluntary participation in the Fitness classes.

        6.       This Agreement applies to personal injury or death arising from my participation at all locations where classes are is taught by Holly Hull, including the facility in and around the facility where the Fitness classes are taught and includes all claims for damages of any kind and for loss of property.

        7.       I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. This agreement remains in effect for as long as I participate in Fitness classes.

      • Has your doctor ever said that you have a heart condition and should only do physical activity recommended by a doctor*
      • Do you feel pain in your chest when you do physical activity?*
      • In the past month, have you had chest pain when you were not doing physical activity?*
      • Do you lose your balance because of dizziness or do you lose consciousness?*
      • Is the a history of coronary disease in your family?*
      • Do you suffer from high cholesterol?*
      • Are you pregnant or have given birth in the last 6 months?*
      • Have you had surgery recently?*
      • Do you have any chronic illness or physical limitations such as Asthma, Diabetes, etc?*
      • Do you have a bone/joint problem that could be made worse by physical activity?*
      • Are you on any prescription medication that may affect you when doing physical activity?*
      • Any other factor which may affect your ability to participate in physical activity?*

      • To pay the £5 to secure your childs space a invoice will be generated and sent to your email. The invoice may take up to two weeks to arrive, if it has not arrived by then please email bhc@salisburycitycouncil.gov.uk or call 01722417100

        The invoice must be paid prior to the event. 

      • Photography - We may wish to take group photographs of the children for publicity purposes this includes social media, please tick appropriate box.*
      • Going Home Procedure - It is very important that the correct instructions are given for how your child will go home after the club. If you tick to say that your child/ren will be collected we are duty bound to keep them on site until they are collected, if for any reason you wish them to walk home on their own on a specific day, we need verbal or written consent from a parent or guardian, not the child.*

      • Payment Methods

        Choose from one of the PayPal options to make your payment.

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