Participant Registration Form

Order#*

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Participant Details

First Name (participant)*

Last Name*

Age (at the course start date)*

Medical Needs

Dietary Requirements

Additional Information

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Parent/Guardian Details

First Name (parent/guardian)*

Last Name*

Email*

Phone - to be used in an emergency*

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Consent

Please consider the following and tick to indicate your consent.

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At certain camps it may be possible to swim in a pool. Do you consent to your child going swimming whilst under the supervision of an adult.*

Yes - I consent to my child going swimming

No - I do not want my child to be allowed to go swimming

At certain camps it may be possible to make use of a skatepark (this may be unsupervised). Do you consent to your child using the skatepark at their own risk?*

Yes - I consent to my child using a skatepark

No - I do not want my child to be allowed to use a skatepark

At certain camps it may be possible to use trampolines (this may be unsupervised). Do you consent to your child using the trampolines at their own risk?*

Yes - I consent to my child using a trampoline

No - I do not want my child to be allowed to use a trampoline

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We may send a photographer to take photos/videos during the camp. Please indicate whether you mind your child being photographed. We may distribute the photographs to participants and we may also use the photos in promotional materials.*

I am happy for my child to be included in photographs & videos taken during the camp and consent to them being shared and used for promotional purposes.

I do not want my child to be photographed or filmed.

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I hereby give my consent that my child may arrive/depart without adult supervision (If you don't consent to this then you must ensure that you drop off and collect your child).*

My child is free to arrive and depart unsupervised

The participant will be collected by myself or another nominated adult (please include their name(s) below.

Name(s) of adults authorised to drop-off and collect participants

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Declarations

At English in Action, we place the highest priority on the safety and welfare of our students and staff. Since our inception we have maintained an excellent record. We ask for your cooperation in assisting us to maintain the very highest standards with the participants you have entrusted to our care. If you are unable to complete these declarations then unfortunately we cannot accept your booking, in this case you will need to contact us for a refund. Terms & Conditions must be read and understood before completing the declaration below.

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Consent to Terms of Booking*

I have read the terms & conditions. I understand them and my child agrees to comply with the terms of the booking, the centre regulations and with the law.

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Consent to Medical Authority*

In the event of my child requiring medical attention during the period of the course, I agree that a responsible adult nominated by English in Action may sign any medical consent forms in consultation with a qualified medical doctor.