Premier League Kicks

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Premier League Kicks - Gresham

Project: PL KICKS
Venue: Gresham Sports Pavillion
Type of activity: Football/Boxing
Date: Every Friday during term time
Time: 6pm - 7pm

PLEASE BRING: Appropriate clothing (including shin pads), refreshments and appropriate footwear (NO STUDS, astroturf trainers / moulded boots permitted). If you are wishing to take part in boxing, please ensure you have appropriate indoor footwear.

Please note your child must be between 8 and 18 years to receive a free place.

In order to take part in this activity, we need to collect basic details about the participant, including information about their health, any disability and other additional needs. We need this information to provide appropriate care and support to the participant during the activity and take appropriate emergency action if necessary.

A requirement of this funding is that we collect information from participants to understand the impact of our activities. We also use this information to improve our work. Notts County Foundation and Support Through Sport will collect and use your child’s information to report to their funders, as well for our own monitoring and evaluation. All personal data will be kept confidential and no personal data will be shared.

For further information regarding our data collection, please contact Lauren Cotton on lauren.cotton@nottscountyfoundation.org.uk.

DATA:

The information provided on this form will be held securely and will only be shared with those who need this information in order to keep the participant safe and meet the specific needs of the participant during the activity. Anonymised information relating to age, gender, postcode, disability/additional needs and ethnicity may also be used for reporting purposes.

PHOTOGRAPHS:

In accordance with our Safeguarding Policy we will not permit photographs, video or other images of adults taking part in Club activities to be taken without the consent from themselves or a parent/carer. Occasionally we may take pictures and allow filming/recording for training or promotional purposes. By signing this consent form you agree to permit Notts County Foundation and/or any person authorised on their behalf to take and publish images taken of the adult named and set out below. We will take all steps to ensure that images are used solely for the purposes agreed by you.

We will not use the full name stated below in any accompanying text or photo caption on our website, social media platforms or in any of our printed publications.

This consent is valid for five years from the date that it is signed. You, or your child, can withdraw your consent at any time please contact Lauren on lauren.cotton@nottscountyfoundation.org.uk. All data held by us will be stored/processed in line with our Privacy Notice.

Which activity would you like to sign up for? *

⁹

Boxing

Both

What is your child's first name? *

What is your child's surname? *

What is their date of birth? *

YYYY

What is their ethnicity? *

White - British

White - Irish

White - Gypsy or Irish traveller

Any other white background

Mixed or Multiple ethnic groups - White and Black Caribbean

Mixed or Multiple ethnic groups - White and Black African

Mixed or Multiple ethnic groups - White and Asian

Any other Mixed or Multiple ethnic background

Asian or Asian British - Indian

Asian or Asian British - Bangladeshi

Asian or Asian British - Chinese

Any other Asian background

Black- African

Black - Caribbean

Any other Black, African or Caribbean background

Arab

Any other ethnic group

Prefer not to say

What is their gender? *

Male

Female

Prefer not to say

What is your postcode? *

Please give details of any disabilities, additional needs or cultural needs that may affect participation in the activity? *

Please give details of all medical conditions e.g. asthma, allergies, illnesses or injuries that might affect participation in the activity? *

Please give details of any dietary requirements? *

I confirm that the participant is otherwise in good health and is capable of taking part in the activity. I confirm that I have given details of all medical conditions above (parental permission) *

Yes

I give my consent to the participant taking part in the activity specified above (parental permission) *

Yes

Please indicate whether you give permission for pictures of your child to be taken for reporting, marketing and promotion purposes. This includes social media. I also consent to Notts County Foundation and Support Through Sport to keep this images on file for an indefinite period. *

Yes

PARENT SIGNATURE (DIGITAL) *

Emergency contact 1 name *

Emergency contact 1 number *

Emergency contact 1 email *

Emergency contact 2 name *

Emergency contact 2 number *

Emergency contact 2 email *

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