Ashley Membership & Medical Consent Form 2023 - 2024 (Girls Y4

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Ashley Membership & Medical Consent Form 2023 - 2024 (Girls Y4 - Y9)

Bank Details

Account Name: Ashley Club

Sort code: 01 - 02 - 02

Account Number: 21868476

Reference: Club fee 23 - 24 & ( Girl Name)

INDIVIDUAL MEMBERSHIP: £100 per year

FAMILY MEMBERSHIP: ( 2 or more sisters) 150 per year

One - off attendance: £5

Taster session for free

Name of member *

Date of birth *

YYYY

School attending *

School year *

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Required

Names of Parents/Guardians *

Parents email address *

Phone number of parents *

Address *

Medical Form

Is your daughter currently receiving any medical treatment and has she been given specific advice to follow in emergencies ? If yes please give full details (e.g type of allergies, medical treatment, etc) if helpful, please send us medical documents.

Any dietary requirements? *

I agree for my daughter to receive basic First Aid by any members of staff present. *

Yes

Consent

I confirm that my daughter is able to swim and consequently I am happy for her to participate in activities involving water

Yes

No, she cannot swim

Clear selection

I agree to my daughter taking part in any or all Ashley activities as proposed unless I say otherwise in writing *

Yes

I have ensured that my daughter understands that it is important for her safety the rules and instructions given by the leaders in charge are obeyed. *

Yes

I understand that while the leaders in charge of the group will take reasonable care of the girls, they cannot be held responsible for any loss, damage or injury.

Yes

Clear selection

I consent to photographs of the above being used in Ashley Instagram, on the understanding that they will not be accompanied by any personal details which may identify the child

Yes

Clear selection

I consent for my daughter to be in the car with another parent or leader as a means of transport to and from activities

Yes

Clear selection

I consent for my daughter to share her mobile number with other leaders - for girls in years 9 and above.

Yes

N/A for daughters in years 4 - 8

Clear selection

I am happy to help

Once a month

Once a term

Once a year

Most of the time and can stay

Clear selection

I could drive my car for outings *

Yes

Would you like to run an activity ?

Yes

Which activity

Clear selection

Date

YYYY

Submit

Clear form

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