JUDO

Parental Consent & Registration Form

A Different Way, Instilling a love of sport ensuring life long participation.

Following your child's free tasters we hope that you entrust us with the development of your child, it is a responsibility we do not take lightly. On your child completing their two free taster sessions you will receive an estimate of your monthly fees together with full membership details.

Child's Name

First Name

Last Name

Date of Birth

Please note American date format

YYYY

Judo experience

Please note you do not need any to participate in the sessions

Name of School

What does your child like most about playing?

Parent's Name

First Name

Last Name

Contact Number

House/ Flat Number

Street

Town/ City

Post Code

What do you like most about watching your child play?

What would you like us to help your child achieve?

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Mobile Number

Any Medical, Allergies or Special Needs?

Any medication they are currently taking?

How did you hear about us? (Please state name if referred by a friend)

Membership Fees

Please note membership fees are done on a monthly standing order after your two free taster sessions

Monthly Single Session (1 per week) £25.00

Joining Fee

£30 (includes your 1st years insurance and judo suit & belt)

Signature

Data Protection: Here at Active Future Northumberland we take your privacy seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us. Please click below for our full Privacy Policy. http://www.thefutsalpartnership.com/privacy-policy/ However, from time to time we would like to contact you with details of other events and offers and with information such as newsletters and company updates. We will never pass your details on to any 3rd parties for marketing purposes. We may also, from time to time take photographs for marketing purposes by ticking the box below you are providing your consent for us to do so. Safeguarding: It is your responsibility to ensure your child is dropped off and collected safely by a parent or guardian from any of our events (sessions/ holiday weeks etc) we will do our upmost to ensure this.

Signed

I can confirm that I agree with the terms and conditions and by clicking submit I am electronically signing the consent form

I agree to the above statement

JUDO

Parental Consent & Registration Form

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