Registration Form REGISTRATION FORM Confidentiality: Details on this form will be held securely and will only be shared with coaches or others who need this information in order to meet the specific needs of your child. PERSONAL INFORMATION – CHILD / YOUNG PERSON Name Address Date of Birth /Month /DayYearDate Previous Academy School Gender MaleFemaleAnother description (please state) Are there any activities in which your child can not participate? NoIf Yes please give details PERSONAL INFORMATION - PARENT / GUARDIAN Name Contact Numbers Email example@example.com EMERGENCY CONTACT INFORMATION Name of alternative adult to contact in an emergency Relationship to child/Young person Contact numbers of alternative adult MEDICAL INFORMATION MEDICAL INFORMATION No Yes If Yes Please give Details Are there any specific medical conditions requiring medical treatment? Details of medication required (e.g. pills, inhaler) Are there any other medical conditions or disabilities to be aware of? Do they have any allergies? Are there any dietary requirements (including vegan / vegetarian)? Upload ID and Photo Browse FilesDrag and drop files here Choose a file Cancelof DECLARATION OF CONSENT - PARENT / GUARDIAN I confirm my registration - child / young personI give my consent that if an emergency medical situation arises, the organisation / club may act in loco parentis for administration of first aid and/or other medical treatment that in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances all reasonable steps will be taken.I confirm that I am happy for my child is to take part in activities. Signature Print name Todays date /Month /DayYearDate Submit Should be Empty:
