Community Sports Hub Navan - Family Multi-Sport Activities                                                              Saturday 11th February 10:30am                              Participant Registration Form
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Participant Details
Parent / Guardians Full Name *
Name of second parent / guardian if attending
Child's First Name & Age  *
Any other childing attending - name & age 
Email *
Phone number *
Address *
Adult Age Group *
Declaration and Release
I hereby give my full permission for the use of my name, picture, image, likeness, actions, voice, video footage  that I am featured in, in whole or in part, individually or in conjunction with other images or videos, as part of my participation in this programme and by all submissions of reports, of media and for purposes of promotion through www.meathsports.ie and associated programmes. *
I understand that the information I provide in this form will be used for monitoring and evaluation purposes and will be shared with other stakeholders for the same purpose. I understand that my name will not be shared as part of this process. *
Readiness to Participate
I have no health related reasons (medical, mental or physical) which would prevent me from participating in this programme. *
Required
I certify that I am medically, mentally and physically fit to participate in this programme. *
Required
In the past week, on how many days have you done a total of 30 mins or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job. Please circle the relevant number: *
In the past week, on how many days has your child done a total of 60 minutes or more of physical activity, which was enough to raise their breathing rate? This may include sport, exercise, and brisk walking or cycling for recreation or to get to and from places, but should not include housework. *
Can the LSP follow up with you after 3 months to ask you the above question again? *

I understand by participating in any exercise or exercise program, there is the possibility of physical injury. In addition to giving my permission for my child’s/person in my care`s participation in this exercise programme, I do hereby waive, release and discharge Meath Local Sports Partnership, its officers, coaches, and representatives from any and all claims or causes of action, known or unknown, arising out of my child’s/person in my care`s participation in this programme.

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Thank you for completing this form. A welcome email with app relevant nformation about the event will be sent out a couple of days before the event. Please tick the box below to confirm you have read this form.  *
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