The Academy Annual Membership, Information and Consent Form

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This form is to be completed by the parent or legal carer and child at the start of each year. Parents or legal carers are responsible for informing The Academy of any changes as they occur.

It is important that you fill in the rest of this form as fully as possible. Failure to tell us important information could mean that the safety and welfare of your child is compromised. The Academy cannot be held responsible if information has not been shared.

Email Address *

First Name of Child *

Surname of Child *

Date of Birth

YYYY

Home Address *

Contact Number *

Health Issues *

Does your child have any health issues such as, allergies, eczema, sight problems, etc..?

Yes

Medical Information *

Please state the name of their health issue and what, if any, medication is required.

Medical Training *

Do The Academy coaches/teachers need any medical training other than First Aid to care for your child?

Yes

Communication *

Does your child have any Communication Needs? e.g. non-English speaker/hearing impairment/sign language user/dyslexia?

Photo Agreement *

I agree to let The Academy take and use photos or videos of my child for promotional or coaching purposes.

Yes

Code of Conduct *

I agree to adhere to guidelines and codes of conduct that will be issued in the interest of safety.

Yes

Consent *

The Academy classes are non-gender specific. I accept that it is my responsibility to inform The Academy directly of any changes to the details recorded on this form. I understand that my son/daughter will participate in The Academy activities as detailed above.

Yes

Name *

Please print your name below to confirm you give consent for your son/daughter to participate in The Academy Programme.

Date Agreed *

YYYY

Submit

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