ACTIVATE sign up form
FREE, FUN and SAFE socially distanced sessions for ages 5-14 in central Cambridge

Parents/carers must complete this form on the participants' behalf. All answers should relate to the young person's information.

When signed up, you will be emailed the booking confirmation and a safety guide at least 48 hours before the session date.
What ACTIVATE session/s do you want to attend? (Click as many times as you'd like to attend: there is limited space so please click the sessions you can definitely attend)
W/c = Week commencing
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Mondays: Coldham's Common
Wednesdays: Meadows Community Centre
Fridays: King George V
What session timing will your child be attending?
Year = 2019-20 academic year groups
Clear selection
Data Collection and Protection
Cambridge United Community Trust (CUCT) receives funding from the Premier League Charitable Fund to deliver our Premier League Kicks Programme to young people in central Cambridge. A requirement for this funding is that we collect information from participants to report back to the Premier League Charitable Fund, as well for our own organisational monitoring and evaluation. This information reported back to the Premier League Charitable Fund will be anonymised. All personal data will be stored securely, kept confidential and will not be shared. However, if we think there is a risk of serious harm to our participants or anyone else, we will have to ask for help, which might mean we need to give the participants' name to the relevant authority who can help them.
Participant gender *
Does the participant have a: disability, medical condition and/or allergy's? *
If YES please state their disability, medical condition and/or allergy's
Participant ethnicity *
Choose one
Participant Full Name *
Participant Date of Birth *
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Our Media Policy
CUCT activities may be recorded through photographs, videos and/or quotes for participants to celebrate their experiences. CUCT are committed to protecting and promoting the welfare and well-being of all participants in relation to privacy. Therefore, please note that any quotes, photos and/or videos published will NOT be accompanied by any personal details of participants other than their first name and age without consent by the parent/carer of participants under 16. These quotes, photos and/or videos may also be used for future publicity for CUCT and/or Cambridge United Football Club (CUFC) websites and/or social media platforms, which will be their only purpose for use. If you change your mind and wish to withdraw consent for the use of images, videos and/or quotes of the participant/s at any time, please email sam.squire@cambridge-united.co.uk.
Do you give consent for Cambridge United Community Trust to take media in accordance with our media policy? *
Does your child receive free school meals? (Please note: all participants will receive a healthy meal regardless of the below answer)
Clear selection
Address *
Post Code *
Emergency Contacts
Please note that the emergency contact details should not be the participants'
Emergency contact name *
Emergency contact number *
Emergency contact email address *
Secondary Emergency contact name *
Secondary Emergency contact number *
Secondary Emergency contact email address *
First aid
If a participant gets injured, a member of their household can assist them, if present, but others will still need to socially distance. If this happens, the first-aider (coach) will be equipped with the appropriate Personal Protective Equipment (PPE) to protect themselves and others if they need to compromise social-distancing guidelines to provide emergency medical assistance.
I Hereby Give Consent for CUCT staff to compromise socially distancing guidance to provide first aid if needed. *
Do you want CUCT to update you on their FREE, FUN and SAFE sessions for young people in the future? *
Questions or Enquiries?
Contact sam.squire@cambridge-united.co.uk or visit @cuctplkicks on Instagram/Facebook and direct message them.
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