Parent/Guardian consent form – 18 and under PRIVACY NOTICE In order to provide an effective service to those taking part in our activities, it is necessary for Pembrokeshire Weightlifting (known as Strength Academy Wales) to collect some personal information in this form. Information collected will be used for the purposes of the legitimate interests pursued by Pembrokeshire Weightlifting and data will be stored and protected in compliance with our legal obligations to meet GDPR standards.Child’s detailsName*Date of birth* DD dash MM dash YYYY Gender* Male Female Prefer not to say Ethnicity*White - English, Welsh, Scottish, Northern Irish or BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - Any other White backgroundMixed or Multiple ethnic groups - White and Black CaribbeanMixed or Multiple ethnic groups - White and Black AfricanMixed or Multiple ethnic groups - White and AsianMixed or Multiple ethnic groups - Any other Mixed or Multiple ethnic backgroundAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - Any other Asian backgroundBlack, African, Caribbean or Black British - AfricanBlack, African, Caribbean or Black British - CaribbeanBlack, African, Caribbean or Black British - Any other Black, African or Caribbean backgroundOther ethnic group - ArabOther ethnic group - Any other ethnic groupPlease select from drop down listWelsh/English Speaker* Welsh Speaker English Speaker Prefer not to say Does your son/daughter have a disability / impairment* Manual Wheel Chair - self propelled Manual Wheel Chair - assisted Electric Wheel chair user Learning disability - moderate Learning disability - severe Visual impairment Hearing impairment Amputee Other physical disability Speech and Language / communication difficulties No Parent / Guardian contact detailsName*Email* Gender* Male Female Prefer not to say Home Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code Home - Contact phone number*Work - Contact phone number*Mobile - Contact phone number*1. Please read and agree to the belowPlease read and agree to the below 1. If you know or are concerned that your child has a medical condition which might interfere with them taking part in our activities, before they take part you should seek advice from a relevant medical professional and follow that advice. 2. Your child will be made aware of rules and instructions. Exercise carries its own risks. Your child should not carry out any activities which they have been told are not suitable for them. 3. Your child should inform us immediately if they feel ill when taking part in our activities. 6. You agree to your child taking part in the activities held in conjunction with Pembrokeshire Weightlifting (Known as Strength Academy Wales) 7. You confirm that your son/daughter is able to exercise safely. 8. In an emergency you agree to your son/daughter receiving medication and any emergency treatment, as considered necessary by the medical authorities. 9. You understand that activity images at the facility may be used for promotional purposes. Both I and my son / daughter understand and agree to follow the above statements* Tick box to sign 2. Medical conditionsDoes your son/daughter have any medical conditions that may affect them, during exercise activities?* Yes No If YES, please give brief details:Does your son/daughter have any allergies (including allergy to medication):* Yes No If YES, please give brief details:Does your son/daughter take any types of medication* Yes No If YES, please give brief details:Has your son/daughter had an illness, injury or accident that may affect them, during exercise activities?* Yes No If YES, please give brief details:Are there any other details you need to inform us about which may affect your son/daughter exercising at our centre or with our activities. Are there any other details you need to inform us about which may affect you exercising at our centre or with our activities?* Yes No If YES, please give brief details:
