Playscheme consent form

Every child will need a completed consent form on or before the first day of Playscheme or Football Player Development coaching.

Please complete this consent form for each child attending Playscheme.

Please read these statements before completing the form underneath

General consent

I understand that whilst the staff in charge of the activity will take all reasonable care, they cannot necessarily be held responsible for any loss, damage or injury suffered to or by my child arising out of the activities. I take full responsibility for my child's conduct and behaviour during the activities or should an incident occur through any misbehaviour.

General consent of the parent/guardian

I give permission for my child to take part in the activities, have read and understood the information herein and give my consent to a medical examination of my child when necessary whilst he/she is taking part in the activity. I request that any operation or other measure considered necessary by a medical authority for his/her diagnosis/treatment shall be performed and I hereby give my permission for such procedures to be carried out in an emergency only and for the administration of a local or general anaesthetic if necessary.

Zorbing

This form must be filled out prior to using the zorb balls. Parental consent is required up to the age of 18. Maximum weight for single usage is 130kg/20.4st. Customers with the following cannot take part:

  • High blood pressure
  • Heart condition
  • Epilespy

Transportation

If we have any issues on site that require us to relocate to another NBLT Playscheme site we may transport your child according to our Safeguarding Policy.

Medical consent

I give my consent to a medical examination of my child when necessary whilst he/she is taking part in the activity. I request that any operation or other measure considered necessary by a medical authority for his/her diagnosis/treatment shall be performed and I hereby give my permission for such procedures to be carried out in an emergency only and for the administration of a local or general anaesthetic if necessary.

Photography/filming

Playscheme is great fun and very popular and the local press love including Playscheme over the holidays. I approve for my child to be included in any photographs and/or filming for promotion and reporting.

Data protection

Nuneaton and Bedworth Leisure Trust will hold the information provided for the purposes of administering Sport, Health and Recreation programmes. This information will not be passed onto any other organisation unless permission is first gained from the person named on the form (parent/guardian if under 18). The leader in charge will carry the information on the day of the activity and every precaution will be taken to keep the information in a safe and confidential manner.

Playscheme (24th April 2017 - 22nd April 2018)
Personal details of participant
1st contact in case of emergency
2nd contact in case of emergency
Doctor
Medical information
If yes, please give details of condition, treatment and any prescribed medicines currently taking
Photography
Your details