HAF Consent Form Please enable JavaScript in your browser to complete this form.Venue *Wallace CentreSouth MoorlandsChesterton HighCongleton HighClass Type *WeeklyHolidayChild'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. Food Allergies / Dietary Requirements *If your child have any food allergies or dietary requirements you MUST make us aware of them here to enable us to provide the lunch provisionIs the child attending eligible for Free School Meals? *YesNoDon’t wish to answerI 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 am aware that children are the responsibility of their parent/guardian at a community venue and will remain with them throughout the session. *Please tickI confirm the following: 1. I am happy for my child to participate in the activities and receive lunch/snacks; 2. That the given contact details, medical and dietary information provided is correct; 3. I understand If my child or any member of the household develops any symptoms, test positive for, is awaiting covid-19 test results or is told to self-isolate between the date of completing the booking form and the event date, then my child WILL NOT attend. 4. That children are the responsibility of their guardian at community venue’s and must always remain with them 5. That in the event of accident or incident, first aid will be administered in the event of need 6. That I am aware of how to access the Hubb Foundation’s Data Policy & Privacy Notice (available at their website www.thehubbfoundation.com) *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
