Consent Form Please enable JavaScript in your browser to complete this form.Venue *Wallace CentreSouth MoorlandsChesterton HighCongleton HighBiddulph ValleyClass Type *WeeklyHoliday1 to 1Day *MondayTuesdayWednesdayThursdayFridaySaturdaySundayChild's Name (1st) *FirstLastDate of Birth *Child's Name (2nd)FirstLastDate of Birth Child's Name (3rd)FirstLastDate of Birth Parent's Name *FirstLastMobile Number / Emergency Contact Number *Emergency Contact Numbers: may also be used for informing you of session cancellations, holiday courses and kit orders. It is the responsibility of the parents/named adult to ensure that any named person is aware that I will be holding the information for the duration of the membership.Alternative Emergency Contact Number *Email *Medical conditions, medications taken or disability diagnosis *Medical exclusions for Trampolining are: Detaching retina, rodded back, brittle bones, and pregnancy. Participants with Downs Syndrome require a form to be completed by the doctor prior to participating. I would like my child/myself/client to participant in trampolining and understand there is an element of risk. No liability will be accepted. in respect of injury, loss or damage caused whilst attending. I agree *Please tickI have read and agree to abide by the Clubs 'Code of Practise *Please tickPlease follow link to read: code of practiseI have read and agree to abide by COVID-19 Guidelines *Please tickPlease follow link to read: covid-19 guidelinesI have read the Club's Privacy Notice I give/withhold my consent for personal data to be processed in compliance with GDPR. *GiveWithholdPlease follow link to read: privacy policyI have read the club's 'images and words policy' and give or with hold permission for my child's/mine or clients images and words to be used on our website, social media, local press and leaflets *Give permissionWithhold permissionPlease follow link to read: images and words policyI will ensure my child is at the session and collected from the session on time. I will make sure my child knows to only leave the sports hall when I have arrived. *YesNoIf my child is allowed to leave the sports hall to meet me or allowed to walk home from the session I will make them aware of this and this is my responsibility *Please tickType name to Sign – Parent/Guardian *I confirm that all information given in this form is correct. By typing my full name into this box, I consider this to be legally binding signature.Submit
