Multisports Camp (7-12) - August 2021
This form must be completed for all participants. It must be completed and signed by an authorised adult eg Parent, Guardian, etc
Email *
Dagenham & Redbridge FC Community Trust is a Registered Charity #1141511
PERSONAL INFORMATION RELATING TO THE PARTICIPANT
Please ensure that all information entered is correct.
This MUST be completed by a parent, guardian or responsible adult
Please indicate which weeks you are registering your child for. *
Required
Payment Details
The cost of each week (5 days) is £40 per child and MUST be paid in advance. Your child's place is not guaranteed until payment has been received. You can pay by cheque, online BACS or cash. Please indicate your method of payment below. You will be contacted as soon as you have registered. NB Payments are not refundable if cancellation is requested after 11th July 2021
How do you wish to pay? *
First Name of Child *
Last Name of Child *
Gender of Child *
Date of Birth of Child *
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School/College/Academy Attended by Child
Which Ethnic Grouping Best Describes Your Child? *
Does Your Child* Have Any Disabilities? *
If You Answered 'Yes' To The Previous Question Please Give Further Details Below
Does Your Child* Have Any Medical Conditions, Allergies, Illness, Physical Or Learning Disabilities That Should Be Brought To Our Attention? *
If You Answered 'Yes' To The Previous Question Please Give Further Details Below
CONTACT INFORMATION
Please include as much information as possible. Please ensure that all telephone numbers and email addresses are correct.
Home Address *
Home Postcode *
Home Telephone No
Contact Details for a Child (17 and below) Registration Only
To be completed by a parent, guardian or responsible adult
Mothers Contact Telephone Number
Mother's E-Mail Address
Father's Contact Telephone Number
Father's E-Mail Address
Guardian's Telephone Number
Guardian's E-Mail Address
Other Contact Emergency Telephone Number
Name of Other Contact Emergency Person
CONSENT
Please read all of the information below very carefully and contact the Trust if you are unsure about anything.
From time to time the Trust may take images (photos or video) of the people participating during Trust activities for promotional use by the Club and/or the Trust, including matchday programmes, social media, etc. Do We Have Your Permission To Take And Use Such Images? *
I give permission for Trust or Club staff to administer First Aid if necessary, and to transfer my child to hospital should an emergency arise. *
Is There Any Other Information You Think We Might Need?
I wish for my child to be accepted for Trust activities and I agree to the terms, conditions and points indicated above. I confirm that any medical conditions which may affect my child’s participation within the activity have been fully disclosed.
Please add your Full Name and Date in the sections below
Name of Person Completing Form *
Date Form Completed *
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Dagenham & Redbridge Football Club Community Trust would like to occasionally send you information about new opportunities and activities? If you wish to opt out, please tick below.
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