Handsworth Sports Session

YMCA Sutton Coldfield run Football sessions every Monday (during term time) at Laurel Road Sports & Community Centre in Handsworth, Birmingham. Please fill out this online consent form for your child to attend

Child's Name *

First

Last

Child's Gender *

Child's Date of Birth *

Child's Age *

Child's School *

Child's Home Address *

Please fill out your address including house number, road name, area, city and postcode

Child's Medical *

Asthma, Eczema, Medication, etc.

Child's Disabilities (Please State) *

This includes ADHD, Autism, Sensory Issues etc.

Dietary Requirements *

Please fill this information correctly so we are able to know in advance yourchild's dietary requirements

Food Allergies or Intolerences

Staff Awareness

Is there anything Staff should be aware of about your child?

Main Contact Name *

First

Last

Relationship to Child *

Main Contact Telephone Number *

Main Contact Email

Additional Emergency Contact 1 *

First

Last

Please fill out an Additional Emergency Contact details. This person need to be different to the Main Contact but over the age 18

Additional Emergency Contact Relationship to Child *

Additional Emergency Contact Telephone Number *

Consent *

I consent photos/videos of my child to be taken and used for YMCA marketing purposes, including website, marketing promotions and social media
I agree to my child/young person being transported in YMCA minibuses, private hire vehicles including coaches or public transport
I consent that my child can make their own way home from YMCA Sports Sessions/Trips
I consent to the named child/young person receiving any emergency treatment whilst in the care of YMCA Sutton Coldfield, including dental, medical or surgical treatment including administration of anaesthetic. We will always follow the advice of the medical practitioner treating the named child/young person. (Every POSSIBLE EFFORT will be made to contact you and an emergency contact)

Please read each one and tick if you're happy to consent to this. By leaving it blank you are stating you DO NOT consent.

Consent to Contact Your Child *

I consent for my child to be contacted by YMCA Staff about Sessions & Trips
I don't want my child to be contacted, please send all details to the Main Contact

Please tick if you're happy to consent to this. By leaving it blank you are stating that you DO NOT Consent

Child's Number