Youth, Community & 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 (1st March 2019 - 7th April 2020)
Target Qualification (1st March 2019 - 7th April 2020)
Player Development (1st March 2019 - 7th April 2020)
Personal Details of the participant
Child's Medical Conditions, Disabilities and/or Allergies
Parent / Guardian Name & Number
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 (other than emergency contacts). Only people named as an authorised person or emergency contact will be allowed to collect your child.
Doctors Surgery & Name
1st contact in case of an Emergency
2nd contact in case of an Emergency