Teviot Rangers participant registration form - Comets pan-disability football for 5

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Teviot Rangers participant registration form - Comets pan-disability football for 5 - 11 year olds

Thank you for registering your interest, please take five minutes to fill out the below form.

If you are registering on behalf of somebody else to attend the session, please fill the below form with their details.

Comets offers a new, flexible and inclusive way of playing, one that’s all about playfulness, friendships and having fun. More than anything, Comets is football that breaks the old rules and replaces them with a brand new one: JUST BE YOU.

These sessions are pan-disability for children and young people 5 - 11 year olds and are open to all abilities/ disabilities. Sessions are inclusive to children who are neurodivergent such as Autism or ADHD, learning disabilities, have a physical impairment, visual or hearing impairments, mental health conditions or long term health conditions.

For children that have a physical disability or use a frame, sessions will be adapted and the Coach will ensure they are non-contact.

Sessions cost £3 per session and there is a maximum of 8 spaces per week.

Please note, we use Spond to manage the bookings. Once you have accepted the link to join the group on Spond, your child's name and guardian name will appear on the members list. If you do not wish for this to be seen, please let us now so we can only use your child's first and last initial. Spond's GDPR policy can be found here: https://help.spond.com/en/articles/25783-gdpr-support-in-spond

Session Details:

When: Saturdays (twice a month) 12 – 1 pm

Where: Slade Hall, SE18 2PQ

Age: 5 – 11 years old

Cost: First session free, £3 per session

Important Information

- Sessions are taught by a qualified FA coach who has a valid DBS check, first aid and safeguarding certificate.

- Sessions will take place indoors in the sports hall until April 2024

- If you need 1:1 support, please bring a parent or carer with you

- Please bring anything that will support you during the session including medication

Your personal information will be used for monitoring and evaluation purposes by Access Sport and will be stored on a secure database only accessed by trusted staff members of those organisations. Please find Access Sport's GDPR policies here - www.accesssport.org.uk/policies

If you have any other questions or want to find out more about the sessions, please contact Disability.Inclusion@AccessSport.org.uk or call 020 7993 9883.

Email *

Participant's first name *

Participant's surname *

Participant's date of birth *

Participant's postcode (not full address) *

What borough do you live in, or would travel to for inclusive activities? (Please tick all that apply)
If not listed, please type all relevant boroughs in 'other' *

Bromley

Bexley

Croydon

Greenwich

Lambeth

Lewisham

Newham

Southwark

Tower Hamlets

Other:

Required

Participant's ethnicity/background *

Black/Black British/Black African/Black Caribbean

White/White British/White Other

Asian/Asian British/Asian Other

Mixed/Multiple Ethnic Background

Prefer not to say

Other:

Participant's gender *

Male (including transgender male)

Female (including transgender female)

Non-Binary

Prefer not to say

Prefer to self-describe as... (please state in 'other')

Other:

Does the Participant have an Impairment/Long-term health condition? *

None

Moving around including walking and running

Using your hands for writing or to pick things up

Seeing and using your eyes

Hearing and using your ears

Speaking and communicating

Breathing (for example asthma)

Difficulty learning new things

Attention differences (for example ADHD)

Social and or communication differences (such as autism)

Reading or writing (for example dyslexia)

Using numbers (for example dyscalculia)

Co-ordination (for example dyspraxia)

Your mental health and how you feel

Gives you pain

Affects your health for a long time (for example a long-term health condition)

Prefer not to say

Affects you in another way, please state in 'other'

Other:

Required

Emergency Contact Name and Number *

Please provide further details and/or medical conditions that we should be aware of to best support the participant

For example: Communication preferences e.g. makaton, BSL, non-verbal; Mobility aids used e.g. wheelchair, crutches; sensory needs, interests or triggers.

Does the participant have any medical needs? Please detail *

Do you use a walker, frame, wheelchair or crutches? *Frames aren't currently provided and you should use your own if possible. *

In the past week, on how many days have you done a total of 60 minutes or more of physical activity, which was enough to raise your breathing rate?
*

Would you like to register for the Ignite Newsletter, keeping you up to date about disability inclusive activities and resources across London? *

Yes please!

No thank you

Photo/Video permissions - Photos may be used for our printed/online publicity, as well as within the charity to support funding applications and reports. *

I give permission as the parent/carer/guardian (under 18 only)

I give permission as the participant (over 18 only)

I do not give permission

How did you hear about the session?
*

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