Participant Consent Form

This form must be completed by participants or a parent/guardian/carer if under the age of 18 prior to taking part in any activities. Please answer all the questions

Participants First Name:

Participants Last Name:

Gender:

Male Female Other

Address:

Postcode:

Date of Birth:

Age:

Emergency Contact Number:

Medical Information:

Please Tick (These photos will be used for promotional uses, to help advertise the schemes and programme which we run. The photos may also appear on Fleetwood Town Community Trust / Wyre council official Facebook/Twitter):

It is ok to be photographed by an official photographer and for photo and name to appear in any potential press release that will help advertise the schemes I do not wish to be photographed at any time

Thank you for signing up for this activity. Your answers are confidential. We, FTCT Wyre Council, will find this personal data useful for monitoring the success of our programmes and to help plan future sports activities. We would like to be able to send you details of any further sports opportunities that may be of interest. We will not pass this information to any third party or use it for any other purpose than those mentioned. We will collect and process all personal data in line with the Data Protection Act 1998.

If you do not want to receive information about other sports opportunities, please tick here

I am in good health and I consider myself capable of taking part in the Fleetwood Town Community Trust activity. I have completed the medical details and consent that in the event of any illness/accident, a suitably qualified person can administer any necessary treatment to me. I also accept that there are risks associated in physical activity events and that the event organisers, coaches and instructors will take every precaution to minimise those risks. Any personal information will be held subject to our privacy policy, which is available at http://www.fleetwoodtownfcct.com/privacy-policy/

I agree with the above statement I disagree with the above statement