Name of parent / carer *

First Name

Last Name

Name of participant *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the participant have any disabilities? *

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities’

Yes

No

Please also detail below any important information that BiG needs to be aware of to make your child's experience engaging in football related ABC activities to the best of their capability *

If none please select NONE

NONE

Visual impairment

Hearing impairment

Physical disability

Learning disability

Multiple disability

Other

If not staying with your child / children, do you agree to ensure that your child / children are dropped off no earlier than 5 minutes before sessions start time and collected no more than 2 minutes after sessions finish time? *

Yes

No

Do you agree to ensure that your child bring his / her own water bottle? *

Yes

No

Have you read the risk assessment with you child / children? *

Yes

No

Do you agree to comply with all the terms in the risk assessment? *

Yes

No

Please state how your child / children will travel to and from football sessions *

In family car

Walk

Cycle

Public transport

Combination of the above

Other

Has your child / children ever been tested positive for Coronavirus? *

Yes

No

Do you agree to keep your child / children away from football if they show any symptoms of coronavirus? *

Please note that all participant's temperature will be taken as they arrive and will not be allowed to join in the session if their temperature s high

Yes

No