Active Leader Football Programme for Girls. Participant Registration Form – Brentford FC Community Sports Trust

Welcome to the registration form for the Active Leader Football Programme for Girls. Please complete all sections of this registration form carefully, to ensure we have accurate contact information for you. Please provide a non-school email as we may need to contact you outside school for your volunteering. Any contact will also be copied to the parent/carer/guardian’s email you provide.

This programme comprises the Active Leader course, followed by volunteering at an England Accredited Football Club or Programme. Please download and read the Code of Conduct here which explains your responsibility and that of the England Football Accredited Club for the volunteering phase of this programme. At the end of this registration form, you are asked to confirm that you will uphold your responsibilities in the Code of Conduct.

Course Code *

Participant First Name *

Participant Last Name *

Participant Date of Birth *

Name you wish to be known by *

Preferred pronoun *We are asking for your preferred pronoun for the purposes of helping us address you correctly.

Pronoun to be used *Please enter the pronoun to be used.

Ethnicity *

Participant Email Address *Not school email

Participant Phone *Preferably Mobile Phone Number

Name of School *

Year Group *Scroll down for more options

Participant Home Address *

Address Line 2

City *

County *

Post Code *

Parent/Guardian/Carer Name *

Parent/Guardian/Carer Email Address *

Parent/Guardian/Carer Phone *Preferably Mobile Phone Number

Emergency 1 Contact Name *

Emergency 1 Contact Phone *Preferably Mobile Phone Number

Emergency 2 Contact Name *

Emergency 2 Contact Phone *Preferably Mobile Phone Number

Access Requirements? *Please select 'Yes' if there is any important access information that we should be aware of, eg Wheelchair, hearing, sight, special learning needs (ADHD, Dyslexia, etc.). You will then be able to provide additional information.

Access Requirements *Please detail any access requirements, eg wheelchair, vision impairment, dyslexia, etc. so that our staff can make accommodations.

Medical Issue? *Please select 'Yes' if there is any important medical information that we should be aware of (eg epilespsy, asthma, diabetes, ADHD, dyslexia, and all food or medicine allergies etc.). You will then be able to provide additional information.

Medical Information *Please detail any important medical information that our staff should be aware of (eg epilespsy, asthma, diabetes, ADHD, dyslexia, and all food or medicine allergies etc.) and details of any medication prescribed.

Parent/guardian/carer permission *

YesBy ticking this box I confirm that I have the permission of the parent/guardian/carer shown on this form, to participate in the Active Leader Football Programme for Girls.

Permission to use Photographs and Videos *YesNoWe wish to take photographs and/or videos of students during the Active Leader Football Programme for Girls, which may feature the student named on this form. Please select 'Yes' to confirm that you and the parent/guardian/carer shown on this form grant us permission to use photographs and/or videos of you, your name and spoken words in accordance with the terms of use of the Active Leader privacy policy which can be found by clicking on ‘Our Privacy Policy’ at the bottom of this page.

Data Protection *

YesBy checking this box you confirm that we may contact you and your parent/guardian/carer and emergency contacts using the contact details you have provided and that we may hold this information in accordance with our Privacy Policy. The information on this form will also be shared with the Accredited Active Leader Trainers, your school, the FA, the County FAs and the England Football Accredited Clubs and Programmes where the volunteering is taking place.

FA Volunteering *

YesBy ticking this box I confirm that I agree to undertake 6 volunteering sessions at an England Football Accredited Club or programme for girls ideally before the end of March 2024.

Volunteering information - Please complete

Are you currently playing for a grassroots team? *

Please indicate your availability (days / times during the week and weekend) *

Please indicate how you would travel to the volunteering (click on all that apply) *

Access to bikePublic transportLift with parentOther

Please tell us the type of girls' football you are interested in (click on all that apply) *

Supporting Weetabix Wildcats (an introductory programme for 5-11 year olds)Supporting a girls' team (under 8s, 9s, 10s, 11s or 12s)RefereeingOther

Thank you for registering for this course. Once registered, you will receive a confirmation e-mail, as will your parent/guardian/carer named on this form.