A separate form is required per individual child. Compulsory data is indicated by * PARTICIPANT DETAILS First Name * Surname * Gender * Male Female Other Date of Birth * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year1924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Year Address * Town * Postcode * ENTER PARENT/GUARDIAN/CARER DETAILS (If Participant is under 18 Years) Title - None -MrMrsMissMsPrefer Not To Say Parent Forename Parent Surname Address (if different from child) Town Postcode Telephone Number Email MEDICAL INFORMATION LACD will administer basic emergency first aid in accordance with the relevant medical authorities. LACD will not administer any medicines your child may require, except the emergency use of an epi-pen following an appropriate briefing with the Swim Teacher. If your child requires to carry an epi-pen you MUST discuss this with the Swim Teacher at the start of the first session your child attends. LACD will administer basic emergency first aid in accordance with the relevant medical authorities. LACD will not administer any medicines your child may require, except the emergency use of an epi-pen following an appropriate briefing with the Swim Teacher. If your child requires to carry an epi-pen you MUST discuss this with the Swim Teacher at the start of the first session your child attends. I have read and understood the above statement and consent to LACD administering basic first aid. * Yes No Please detail any medical conditions, including allergies which your child has. * Please detail any medication that your child may require to carry and/or self administer. * AQUATIC ACTIVITY PROGRAMME INFORMATION Click the following link to the Aquatic Activities Programme Information, please read and tick to confirm understanding. I Agree * Yes No EMERGENCY CONTACT DETAILS An emergency contact is required for EVERY participant. (for children contact must be allowed to uplift child and must not be parent/guardien/carer) Please specify below: Name * Telephone No. * Relationship to Participant * ADDITIONAL SUPPORT Please detail any additional support required. * Please detail any information any concerns or particular issues regarding using the swimming pool. * PHOTO CONSENT LACD manage a strict policy on the taking and using of video and photographic images. Participants and members of the public are not permitted to take photographs or videos at LACD activities. LACD obtain consent to enable officers and members of the press to take video or photographic images for official use only. These images may be used on the LACD website, for promotional material or social media for promotional purposes only. Please tick the box if you give permission for your child to be in any photographs or videos for the above purposes only. * Yes No CODE OF CONDUCT LACD asks participants and their carers to adhere to its Codes of Conduct to ensure the health, safety and enjoyment of all participants. Failure to do so could result in the participant being excluded from the class/activity. Examples included in the Code of conduct are: Be safe at all times. Follow the instructions and listen to the activity leader at all times. Respect each other- no hitting/pushing/put downs or swearing. Take care of all property and equipment being used. Do not leave sessions without the permission of those in charge. The full code of conduct can be viewed on our website at https://www.dundeecity.gov.uk/forms/AdobeDocs/codes_of_conduct.pdf I confirm that I have read and acknowledge the code of conduct. * Yes No DATA PROTECTION The personal information you have provided will be held by LACD and only used for the following purposes: To contact you about your chosen course or activity. To provide relevant medical information to staff or emergency services in the event of an accident/ incident. For the prevention and detection of crime. If you have any questions about our Data Protection Policy or the information we hold about you, please contact us on 01382 307485 or email:dataprotection@leisureandculturedundee.com LACD would like to send you information electronically on relevant activities with Aquatic Activities in the future. Please indicate if you wish to receive activity information for Aquatic Activities by ticking the box below. Yes I wish to receive information on Aquatic Activities in the future: Yes No You can opt out of these emails at any time by contactingaquaticactivities@leisureandculturedundee.com at any time. Our booking system generates automated emails as reminders for rebooking and essential booking information when you join a class, by taking part in our activities you agree to receiving this information Leave this field blank Submit
