PARENTAL CONSENT FORM D

JUNIOR REGISTRATION FORM
SECTION 1: PERSONAL DETAILS OF YOUNG PLAYER
Players Name *

First Name Last Name
Date of Birth *
Home Address *

Street Address

Street Address Line 2

City County

Postal Code
SECTION 2: PERSONAL DETAILS FOR PARENT/LEGAL GUARDIANS OF YOUNG PLAYER
Name *

First Name Last Name
Home Address (if different)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email for parent/legal guardian *
example@example.com
Home Phone Number for parent/legal guardian

Area Code Phone Number
Mobile Phone Number for parent/legal guardian *

Area Code Phone Number
SECTION 3: EMERGENCY CONTACT DETAILS

Can we use the above details as a contact in an emergency? If not please provide the contact details of an alternative adult below. As the person completing this form, you must ensure each person whose information you include in this form knows what will happen to their information and how it may be disclosed.
Name of an alternative adult who can be contacted in an emergency

First Name Last Name
Phone Number of an alternative named adult

Area Code Phone Number
Relationship which this person has to the child (for example, aunt,neighbour, family friend and so on)
SECTION 4: Swimming Consent

Swimming is available at some events and will be available for children who can swim over 25 metres Consent must be given before a child can enter the swimming pool facility.
My child can swim 25 metres or more. I consent to my child swimming at your events and will ensure that they bring the necessary swimwear to participate. *

Yes, I consent to my child swimming at your events No, I do NOT consent to my child swimming at your events
SECTION 5: DISABILITY

We will use this information for statistical purposes as well as to establish if there are any additional needs / support / adjustments that your child may require, please discuss this with us.
Do you have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more? *

Yes No
Does this disability or illness affect you in any of the following areas?

Vision Impairment Hearing Imapirment Mobility Impairment Dexterity Impairment Learning Impairment Memory Impairment Mental Health Impairment Stamina, Breathing or Fatigue Impairment Developmental Impairment Has other Type of Impairment, please provide more details
SECTION 6: MEDICAL INFORMATION
Please detail below any important medical information that our coaches need to know and which would affect your child’s participation in cricket activities. Such as: allergies; medical conditions (for example - epilepsy, asthma, and so on); current medication; special dietary requirements, any additional needs, and/or any injuries. Please indicate NONE where appropriate or let us know if you would like to discuss this privately with us. *
GP's Name & Practice Details *
GP's Phone Number *

Area Code Phone Number
MEDICAL CONSENT

I consent to my medical details being shared with coaches/leaders for the purposes of the delivery of my safe participation in the cricket club activity.
Not providing consent will not affect your child’s membership to the Skillz Sports Academy, however giving us consent to share this information will help our Coaches & helpers to know how to respond effectively in the case of any medical emergency.
SECTION 7: PARENT/LEGAL GUARDIAN PARTICIPATION AGREEMENT :
Parent/Legal Guardian Participation Agreement *

I agree to the child named above taking part in the activities of Skillz Sports Academy Ltd I confirm I have read, or been made aware of Skillz Sports Academy Ltd's policies concerning the following, and understand these can be found on the Skillz Sports Academy Website, www.skillzsportsacademy.co.uk
Policies

Changing/showering Transporting Children Photography/Video Managing Children Missing children Playing in open age (senior) matches Social media, text & email
Policy confirmation & agreements *

I understand & agree to the responsibilities which I & my child have regarding these policies I also confirm I have been given comprehensive details of the home & away fixtures in which my child may participate
SECTION 8: SKILLZ SPORTS ACADEMIES PHOTOGRAPHY/VIDEO CONSENT
Photography/Video Consent

I consent to Skillz Sports Academy Ltd photographing or videoing my child and his/her involvement in cricket in line with Skillz Sports Academies photography/video policy.
If you do not wish to give consent for this please contact us to discuss how we can manage any potential photography. Not giving consent will not affect your child’s membership with Skillz Sports Academy Ltd
SECTION 9: PRIVACY STATEMENT

Skillz Sports Academy Ltd take the protection of the data that we hold about you as a member seriously and will ensure that the data you provide is processed in accordance with data protection legislation.
PARENT/GUARDIAN AGREEMENT & MARKETING CONSENT
Skillz Sports Academy uses data for direct marketing, this will give you information relating to our holiday clubs, Overseas & UK Tours, Fixtures and similar events.

I consent to be included in your email/telephone/text marketing campaigns I DO NOT consent to be included in your email/telephoe/text marketing campaigns
By returning this completed form, I confirm that I have legal responsibility of (name of child) and that I have read and understood the permission statements on this membership form and the privacy notice below.
Signature *
Date *

Month Day Year
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JUNIOR REGISTRATION FORM

SECTION 1: PERSONAL DETAILS OF YOUNG PLAYER

SECTION 2: PERSONAL DETAILS FOR PARENT/LEGAL GUARDIANS OF YOUNG PLAYER

SECTION 3: EMERGENCY CONTACT DETAILS

SECTION 4: Swimming Consent

SECTION 5: DISABILITY

SECTION 6: MEDICAL INFORMATION

SECTION 7: PARENT/LEGAL GUARDIAN PARTICIPATION AGREEMENT :

SECTION 8: SKILLZ SPORTS ACADEMIES PHOTOGRAPHY/VIDEO CONSENT

SECTION 9: PRIVACY STATEMENT

PARENT/GUARDIAN AGREEMENT & MARKETING CONSENT