Skellingthorpe After School Club Form
To be completed by all parents of children under the age of 18
Participant Name *
Your answer
Participant Age *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Emergency Contact Email *
Your answer
IS the participant taking any regular medication? If so, for what reason?
Your answer
Does the participant have any long term illnesses or injuries?
Your answer
The participant may have photographs taken during activities which may be used in promotional material and publicity in conjunction with the programmes of Hurricane Sports, including its website. Please identify in the box below if permission is given or not. *
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