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Bar Park Youth sessions sign up form
Please be aware that there are risks involved in taking part in this activity, including physical injury, by filling in this form you are acknowledging that you are aware of and accept these risks and are responsible for your own actions and involvement
If you are under 18yrs, this form will need to be filled in by a parent, carer or guardian
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* Indicates required question
Full name
*
Your answer
Parent/guardian name
*
Your answer
Parent/guardian contact email
*
Your answer
Parent/guardian contact number
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Gender
*
Female
Male
Non binary
Prefer not to say
Post code
*
Your answer
Additional/complex needs
*
Your answer
Allergies (inc food and medication)/injuries/illnesses we should be aware of
*
Your answer
Emergency contact name
*
Your answer
Emergency contact number
*
Your answer
Photo\video permission:
Photos and videos from this project will be published on participants personal social media pages as well as partner organisations and CHISPA media platforms.
Please indicate whether you give permission below.
*
Yes i give permission for photographs\videos to be taken of myself\my child
No i do not give permission for photographs\videos to be taken of myself\my child
Would you like Chispa to contact you with information about future sessions and events like these?
*
Yes
No
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