A separate form is required per individual child. Compulsory data is indicated by * PARTICIPANT DETAILS Child Forename * Child Surname * Date of Birth * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year19741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Year School Stage * Activity PARENT/GUARDIAN DETAILS Parent Forename * Parent Surname * Telephone No. * Email Address * CHILD COLLECTION A member of staff will escort participants and ensure they have been collected safely from their parent/guardian. Participants will exit the facility through the main entrance to the centre. Collection of your child can be from any point between here and the hall where the class is taking place. A Leisure and Culture Dundee employee will escort the kids at all times until a safe handover has been completed. I (the parent/guardian) give permission for my child to walk home. EMERGENCY CONTACT DETAILS (second person) Name * Telephone No. * Relationship to Child * 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 lead coach. If your child requires to carry an epi-pen you MUST discuss this with the coach 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. * ADDITIONAL SUPPORT Please detail any additional support required. * Please detail if your child will require support from a parent/guardian/carer during the class. * 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 (the parent/guardian) give permission for my 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. * 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 our Teen Programme in the future. Please indicate if you wish to receive activity information for our Teen Programme by ticking the box below. I wish to receive information on our Teen Programme in the future * Yes No You can opt out of these emails at any time by contacting leisureactive@leisureandculturedundee.com. Leave this field blank Submit
