KINGSTON TRAMPOLINE ACADEMY

CLUB REGISTRATION AND CONSENT FORM

PERSONAL AND CONTACT DETAILS

Gymnast’s name ………………………………………….. Date of birth……………………......................................

Address……………………………………………………………………………………………………................................

……………………………………………………………………………………………………………..................................

……………………………………………………………….. Postcode…………………………………………..…….…

Contact no. (home)………………………………………… (mobile)………………………………………………….....

Emergency Contact………………………………………………………………………….……………..............................

Contact no. (home)………………………………………… (mobile)……………………………………….……..……..

School…………………………………………………........ . Address…………………….....………………….………..

……….…………………………………………………………………………………………………….................................

MEDICAL/HEALTH INFORMATION

Please give details of any medical condition, health needs and medication that the club should be aware of*:

….………………………………………………………………………………………………………………….......................….………………………………………………………………………………………………………………….......................

Please give details of any allergies

………………………………….......................................................................................................................................Doctor’s Name……………………………………….………...... Contact number……………………………..……………

Please give details of any specific dietary requirements…………………….………………...………………………........

…………………………………………………………………………..……………………………………….......................

* Please supply any additional information on conditions that may require extra consideration by staff. It may be necessary to seek medical advice to confirm that participation in gymnastics activity will not have a negative impact on health. Medical information will be sought and where necessary any screening carried out prior to participation in the sport.

PARENTAL CONSENT

I confirm my child is physically fit and healthy and I will undertake to advise you of any change. I consider him/her capable of taking part in gymnastics. I have completed the section on medical details and give consent that in the event of any illness/accident any necessary treatment can be administered. If surgery is necessary this may include the use of anaesthetics. I can also confirm that all body piercings/jewellery will be removed prior to training.

I confirm that I have read through the participant’s code of conduct with my child and they understand and agree to abide by the rules.

In signing this agreement I declare that I am aware of the element of risk involved and while I accept that the coaches and event personnel will take precautions to prevent accidents, I understand that they may not be held responsible for loss, damage or injury to my child.

I confirm that my child is a current member of British Gymnastics.Their number is …………………………………..

I am aware that photographs and video footage may be taken during the event for coaching and promotional purpose. I do/do not consent (please delete as appropriate) for my son /daughter to appear in photographs. I understand that no personal information will be displayed with the image.

Parent/Guardian Name……………..…………………………………………..............……………………………………...

Signed (Parent/Guardian).………………….…………………………………....… Date…………........……………………

Acknowledged on behalf of Kingston Trampoline Academy………………....… Date…………........……………………

All information will be kept strictly confidential in compliance with the Data Protection Act 1994 and 1998.