Wreake Skills Centre (Ages 7-9 * |
Child's Forename * |
Child's Surname * |
Date of Birth * |
Address Line 1 * |
Address Line 2
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City * |
Postcode * |
Participant Email Address * |
Gender * |
Ethnicity * |
Does the participant have a disability? * |
Does the participant have any medical conditions that might affect participation in the activity? (e.g., asthma, allergies, illnesses, or injuries) and please provide details of any medication that the participant carries with them - Inhaler, EpiPen, Insulin or other. * |
I confirm that the participant is in good health and can take part in the activity. I confirm that I have given details of all medical conditions above. * |
Have you attended our Skill Centre Sessions before? * |
How did you find out about our Skills Centres? * |
Do you play for a grassroots club? * |
If no, would you like us to pass on the contact details for your nearest Grassroots club?
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Please provide details of an emergency contact. |
Emergency Contact Name * |
Contact Number * |
Relationship to Participant * |
Emergency Contact Email * |
Image Consent
In accordance with our Safeguarding Policy, we do not permit photographs, video (including audio comments) or other recorded images of participants who are taking part in our activities to be taken without the consent of the participant (if aged 16 or over) or the parent or carer. If you refuse consent for photos, video and other images we will take all reasonable steps to prevent any recorded images being captured.
If you agree to permit Leicester City in the Community, Leicester City Football Club and/or any person authorised on their behalf to take and publish images of the named participant we will follow best practice by not using the participant's full name in any accompanying text or photo caption. Images and footage may be used for training purposes, to report to funding providers, on publicity and promotional materials including advertising material and printed publications, presentation and display materials, on the official website, social media channels and digital communications materials, and news media including television and radio.
I understand that images will be stored securely and that any images used for publicity or marketing purposes will be in the public domain and could potentially be reproduced, altered or re-used by others.
Consent can be withdrawn at any time by emailing [email protected] although this may not affect images that have already been used.
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I understand the above and give informed image consent. * |
Marketing Consent
We would like to send you news, offers and information about Leicester City activities, events, and services, including our monthly newsletter via email. Please review our Privacy Policy about how we use and process your data. You can contact us at any time by emailing [email protected] if you no longer wish to receive direct marketing.
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I would like to subscribe to Leicester City in the Community's email marketing service, including their monthly newsletter. * |
Privacy Policy
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 and additional needs and ethnicity may also be used for reporting purposes. For more information regarding the Privacy Policy please visit https://www.lcfc.com/club/privacy
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Promotional code |
Leicester City in the Community has a Nut Free Policy to protect people with nut allergies. We will not provide any products containing nuts. Please refrain from bringing any products containing nuts to this event. |
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In accordance with our Safeguarding Policy, we do not permit photographs, video (including audio comments) or other recorded images of participants who are taking part in our activities to be taken without the consent of the participant (if aged 16 or over) or the parent or carer. If you refuse consent for photos, video and other images we will take all reasonable steps to prevent any recorded images being captured. If you agree to permit Leicester City in the Community, Leicester City Football |
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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 and additional needs and ethnicity may also be used for reporting purposes. For more information regarding the Privacy Policy please visit https://www.lcfc.com/club/privacy. |