Memorial Park Sonning Common, Summer Activities

Supported by the Together Fund

Participant Registration Form

The Together Fund is a Sport England fund designed to address the most critical levels of inactivity and the inequality gap across Oxfordshire which is set to widen as a result of the coronavirus pandemic, as well as tackling isolation and loneliness and improving the life chances of the most vulnerable people in our community. The aim is to help reduce the negative impact of COVID-19 and the widening inequalities in physical activity, by providing activities accessible to all, especially those who are disadvantaged or with long term health conditions.

Please carefully complete all sections of this form to ensure we have accurate contact information.

Space is limited on each session and we will contact you to confirm your place is reserved.

Participant First Name *

Participant Last Name *

Participant D of B *

Gender *

Ethnicity *

Participant Home Address *

Address Line 2

City *

County *

Post Code *

Access Requirements? *Please select 'Yes' if there is any important access information that our staff 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 our staff 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.

Eligible for Free School Meals or YouMove Card Holder *

Please click on to highlight the activity(ies) you wish to book for the child named on the form. A separate registration form is needed for each child attending.

Activities

Family Boot camp 9.30am-10:15am Saturday 17th September. Age 8+ children and adults

Parent/Guardian/Carer Name *

Parent/Guardian/Carer Email Address *

Parent/Guardian/Carer Phone *Mobile contact number for emergency

Parent/Carer/Guardian Home Address *

Address Line 2

City *

County *

Post Code *

Emergency 1 Contact Name *

Emergency 1 Contact Phone *Preferably Mobile Phone Number

Emergency 2 Contact Name *

Emergency 2 Contact Phone *Preferably Mobile Phone Number

Permission to use Photographs *YesNoSelect 'Yes' to give permission to use any photos including by Active Oxfordshire for the promotion of physical activity

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.