Consent Form | Sporting Communities

First name of Participant *

Surname of Participant *

Date of Birth *

Post code *

Phone number

Don't answer if you are aged under 16

Email

Gender

Ethnicity

In England and Wales, there are 18 ethnic groups recommended for use by the government when asking for someone’s ethnicity. These are grouped into 5 ethnic groups, each with an ‘Any other’ option where people can write in their ethnicity using their own words. These groups were used in the 2011 Census of England and Wales.

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship to participant *

Are you happy to receive communication about our offers and services? *

If you are completing this on behalf of someone else, please answer the following as the participant.

Do you have any medical conditions? *

Please list any medical conditions, along with any medical requirements. *

Do you consider yourself to have a disability? *

What is the nature of your disability? Please inform us of any additional support that you may require to engage in the sessions activities? *

Are you on the Covid-19 clinically vulnerable list, or are you in direct contact with someone on the Covid-19 clinically vulnerable list? *

Sporting Communities offers fair weather open access play and sports provision across many locations, we do not offer childcare during open access provision. This means that children can decide to come and go as they please, regardless of whether they are accompanied by an adult. All of our provision is open access, unless otherwise stipulated. Sporting Communities recommends that all people accessing our sessions bring along their own PPE, water, suitable clothing and footwear. *

I understand

Sporting Communities is operating to Public Health’s Covid-19 guidelines. As such, we have the right to suspend sessions under our open access guidelines if any risks would deem it appropriate to do so. *

I understand

For Public Health's Covid-19 guidance, please go to https://www.gov.uk/

I agree that first aid and medical treatment can be administered, if necessary in the event of an emergency, including the administration of a general anaesthetic and surgical operation in accordance with the recommendation of a qualified practitioner, in the event that I am unavailable. *

I understand

I give / do not give my consent that I, or the young person named above (if aged under 18) may be photographed and/or filmed during the activity and these images may be used for promotional material by Sporting Communities CIC in the future. (This is in accordance with GDPR and the Data Protection Act). *

Yes - I give consent
No - I do not give consent

If you are completing this on behalf of someone else, please answer the following as the participant.

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