To comply with Health and Safety and Child Protection in sport, please read and complete the following section in full.
Child Name*
Date of Birth*
School Year*
1. Does your child have, or ever had any of the following:
Heart or Lung conditions (Inc. Asthma/ Bronchitis)*
Please provide details*
Experienced Fainting or Dizzy spells*
Please provide details*
Diabetes*
Please provide details*
Any Joint / Muscular conditions*
Please provide details*
2. Is there any other condition that our coaches must be aware of to allow your child to participate safely in the After School Club?
Does your child require an Epipen?*
Please provide details*
If yes please ensure our coaches have your child’s EPIPEN action plan. Your child will not be able to attend the Camp without it.
Is your child/ren on the SEN register or has an EHCP ?(if Yes contact 07761 678535)*
Please provide details*