Registration form for inclusive activities

By submitting this form you confirm that you and the participant accept the code of conduct and new guidance for this activity to go ahead, and agree that the participant may be taken to hospital or seen by a doctor should an emergency arise

What is the activity/venue? *

Participant's name *

Parent or carer's name *

Emergency contact telephone number *

Participant's postcode *

Contact email address

Participant's gender

Participant's date of birth

Any health conditions requiring medication?

Does the participant currently do other forms of exercise? If so, what and how often?

Do you consider the participant to have a disability or impairment?

If you answered 'other' to the previous question, please specify here.

Does the participant have a parent or carer accompanying or supporting them during the activity? *

Any participant requiring individual support must provide this care themselves. Our staff are qualified to deliver safe and suitable activities and are responsible for the group activity and not individual needs before, during and after the activity.

Is there anything regarding communication, understanding instructions, physical ability or behaviour we need to be aware of to make the activity as inclusive as possible? *

Is the participant a wheelchair user?

Please be aware that our live online classes will be recorded for health and safety purposes and will not be shared outside of the organisation.

We often take photographs or video of the sessions to publish to help promote the activities. Do you grant permission for us and our partners to use these photos in this way?

How did you find out about this activity?

We send update emails about further and other activities. Would you like to receive them?

We invite participants to take part in a survey to evaluate the success of the activities. Would you like to be invited?

I understand by completing this form the designated parent, guardian or carer stated on this form is expected to take part in the activity supporting the participant and is wholly responsible for the participant at all times.

As a Local Authority we collect, hold and process information supplied by you in accordance with the Data Protection Act, to allow us to provide services effectively. You can find out more regarding this and our privacy notice here.