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Youth, Community and Sports Activity Consent Form

Every child will need a completed consent form on or before the first day of Playscheme, Football Player Development coaching & Target. 

Please complete this consent form for each child attending Playscheme.


Please read these statements before completing the form underneath


General consent: I understand that whilst the staff in charge of the activity will take all reasonable care, they cannot necessarily be held responsible for any loss or damage to personal possessions or injury suffered to or by my child whilst attending the Play Scheme. I take full responsibility for my child’s conduct and behaviour during the activities or should an incident occur through their misbehaviour.


Transportation: If we have any issues on site that require us to relocate to another NBLT Playscheme site we may transport your child according to our Safeguarding Policy.

Medical consent: I (as parent/legal guardian) give permission for my child to take part in the activities, have read and understood the information herein and give my consent to a medical examination of my child when necessary whilst he / she is taking part in the activity. I request that any operation or other measure considered necessary by a medical authority for his / her diagnosis/treatment shall be performed and I hereby give my permission for such procedures to be carried out in an emergency only and for the administration of a local or general anaesthetic if necessary.

Photography/filming: Playscheme is great fun and very popular and the local press love including Playscheme over the holidays. I approve for my child to be included in any photographs and/or filming for promotion and reporting.

Data protection: Nuneaton and Bedworth Leisure Trust will hold the information provided for the purposes of administering sport, health and recreation programmes. This information will not be passed onto to any other organisation unless permission is first gained from the person named on the form (parent/guardian if under 18) The leader in charge will carry the information on the day of the activity and every precaution will be taken to keep the information in a safe and confidential manner.

Playscheme (17th April 2021 - 16th April 2022)

Personal Details of the participant

Child's Medical Conditions, Disabilities and/or Allergies

Parent or Guardian Name and Number

Parent or Guardian Email Address

Do you give permission for your child’s photo to be taken at any time they are with us? This may appear in newspaper coverage or other marketing material for NBLT

My child is allowed to participate in and be taken off site activities such as attending the park, walks, picnics or other associated activities in close locality to venue

Persons Authorised to collect your child

Please detail people who are authorised to collect your child & their relationship. Only people named as an authorised person will be allowed to collect your child. Please include anyone who will be collecting the children including yourself.

Doctors Surgery and Name

1st contact in case of an Emergency

2nd contact in case of an Emergency

I give consent to Nuneaton & Bedworth Leisure Trust to contact me via email for marketing purposes with services related to children's activities. 

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