Please enable JavaScript in your browser to complete this form.Name *FirstLastAge *Phone NumberEmailFirst line of your addressPost Code *Are you happy to receive promotional communication from Sporting Communities about the programmes we are delivering? *YesNoEmail onlyEmergency Contact Name *Emergency Contact Phone Number *Relationship *Do you have any medical conditions? If so, please list them along with any medical requirements. *Are you on the Covid-19 clinically vulnerable list, or are you in contact with someone on the Covid-19 clinically vulnerable list? *YesNoDo you consider yourself to have a disability? If yes, what is the nature of your disability? Do you require any additional support to engage in the sessions activities? *How would you define your ethnicity?How did you find out about Sporting Communities? *Word of mouthSocial MediaSporting Communities websitePoster / FlyerReferredOtherHave you used any of the following Sporting Communities social media? (Please select as many as are appropriate) *FacebookTwitterInstagramLinkedInYouTubeNoSporting 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 understandSporting 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. If a participant is deemed to have intentionally broken social distancing guidelines, they will be informed that they will no longer able to join in any future sessions. *I understandI 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 I am unavailable. *I agreeI give / do not give my consent that the young person named above 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 consentNo - I do not give consentNameSubmit
