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Activity Holiday Camp Consent Form

Please take some time to accurately fill out this form before your activity camp.

One form must be completed for every individual taking part.

Participant:

Child's Birth Date
Day
Month
Year
Address
Sex for Changing Purposes
Male
Female
Other
Is the attendee's gender different to their sex at birth?
Yes
No

Dietary Needs

As we provide food on camp, please give us detailed information on dietary requirements and allergies.

Does the attendee have any additional dietary needs?
Yes
No

Additional Medical Needs

Does the attendee have any additional medical requirements ie allergies or long term illnesses
Yes
No

Additional Educational Needs

We aim to make our activities as inclusive as possible so please provide as much information as possible below so we can support your young person.

Does the attendee have any additional educational/behavioural needs ie ADHD or delayed processing?
Yes
No

Provision of Medicine

By selecting the below, I give consent for the administration of medicine or medical treatment
In the event of illness or accident, I consent to any necessary external medical treatment ie hospital trips. Please note we will make contact with you if this is required.
Yes
No

Additional Info and Swimming Ability

Tick all that apply:
Swimming Ability:

Emergency Contact:

Please update us if any of the below details change.

Drop off / collection

Disclaimer:

Statement of Risk

GoSport Activity Centre places safety as a priority. Adventurous Activities involve some risk for the people taking part. GoSport Activity Centre and its coaches aim to keep these risks as low as possible. The chances of serous injury are extremely low, but the chance of minor Injuries (bruises. bumps and less likely injuries such as minor fracture) are a possible result of taking part in Adventurous Activities. GoSport and its staff will minimise  the actual dangers by:

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  • Carrying out a careful risk assessment of risks before commencing the activity.

  • Only using experienced instructors with the appropriate qualifications for the activity.

  • Giving clear safety instructions to everyone participating.

  • Ensuring equipment and clothing are well-maintained and are suitable for the activity and environment 

  • Ensuring activities are within the capabilities of the participants.

  • Asking participants to supply any medical conditions or information to allow reasonable adjustment.

  • Ensuring good hygiene standards are kept.

 

We expect participants to co-operate with GoSport and its staff, to ensure the safety of all participants, by following instructions and through the answering of Personal Information Forms honestly especially when providing information relating to health and safety.

Media Permission Statement: By ticking the box below I give permission for my child to be photographed and videoed during the activities. Media taken may be used by GoSport Activity Centre or in conjunction with GoSport Activity Centre.

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