A separate form is required per individual participant. Compulsory data is indicated by * Participant Details Forename * Surname * Date Of Birth * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year18241825182618271828182918301831183218331834183518361837183818391840184118421843184418451846184718481849185018511852185318541855185618571858185918601861186218631864186518661867186818691870187118721873187418751876187718781879188018811882188318841885188618871888188918901891189218931894189518961897189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Year Emergency Contact Forename * Surname * Telephone No. * Medical Information LACD will administer basic emergency first aid in accordance with the relevant medical authorities. LACD will not administer any medicines you may require, except the emergency use of an epi-pen following an appropriate briefing with the lead coach. If you are required to carry an epi-pen you MUST discuss this with the coach at the start of the first session you attend. 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 you have. * Photo/Filming 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. I give permission for myself to be in any photographs or videos for the above purposes only. * 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 Urban Moves Programme in the future. Please indicate if you wish to receive activity information for Urban Moves Programme by ticking the box below. I wish to receive information on Urban Moves Programme in the future: * Yes No You can opt out of these emails at any time by contacting urban.moves@leisureandculturedundee.com. Leave this field blank Submit