Gender
-- select -- Female Male
Date of Birth
Emergency Parental Contact Details
In the event of an emergency relating to the participant please provide information below which we can use to contact you.
Adult Emergency Contact Name
Relationship to Participant
-- select -- Parent Guardian Grandparent Sibling Other
Contact Telephone Number
Email Address
Home Address (if different from above)
Alternative Emergency Contact Details
Medical Information
Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness etc.) or disabilities which we should be aware of?
Please give any details of special dietary needs we should be aware of (e.g. food allergies, intolerances, religious requirements)
Please give details of any behavioural/emotional needs we should be aware of and how we can best support your child or young person
Please give details of any communication, physical or emotional needs we should be aware of
Please indicate if the young person has a history of any of the following:
-- select -- Inappropriate sexualized behaviour Self-harm Violence or abuse of animals Absconding
Interests
For each module that is of interest, please select the level of experience
Mechanics
-- select -- None Limited Good
Animal Care/Equine Handling
-- select -- None Limited Good
Land Based Skills
-- select -- None Limited Good
We may take photographs and videos of activities. These images may be used on social media or for promotional purposes. Please indicate whether you consent to this.
-- select -- I consent I do not consent
Photo Consent
I agree to my son/daughter participating in The Game Change Project and the activities run by the team. I understand that every care will be taken to ensure the health, safety, and welfare of my child. I accept and support the code of conduct for behaviou
Please tick to confirm that the young person has understood and agreed to follow the Code of Conduct for participants
Please tick to confirm that you agree to the Terms and Conditions
IDP
Consent for administering paracetamol
Consent for off-site visits
I realise and accept that in the event of my child’s behaviour adversely affecting the safety of the activity, the organisers reserve the right to require me or any of the emergency contacts to collect return my child home with immediate effect.
I accept and support the code of conduct for behaviour. I support the “no use of mobile phones on site policy” and understand that staff can be contacted in the event of an emergency.
I agree to be contacted by the following method regarding my son/daughter’s progress on the course.
-- select -- Email Phone