Night Flyers Club Registration Form

The following information is essential for the club records and performer safety, insurance and competition purposes. The parent or guardian of the club member must complete it in the child’s presence.

Name:		Age:		Date of birth:
Address:
				Telephone 1:
				Telephone 2:

	Post code:			email:

Have you had, or do you suffer from any of the following. If yes, please give details:

Condition		No	Yes	Details
1	Any serious injuries
2	Broken any major bones
3	Fainting or epilepsy
4	Heart or back problems
5	Allergies
6	Asthma
7	Diabetes
8	Do you carry medication for the above?

If you have answered YES to question 8 please complete the section below:

	Do you administer your own medication ?	No	Yes
	If no, who normally administers your medication ?
	In emergency who may administer your medication ?

Please provide any additional information which you feel may be of use to the club and coaches:

	Please tick this box if you do NOT want photos/videos of your child to be taken during training sessions
	Please tick this box if you do NOT want photos/videos of your child on the club website
	Please tick this box if you do NOT want your child’s name to appear on the club website

I confirm that I am the parent / guardian of the above child. The information above is true to the best of my knowledge, and if any changes to the above details or to my child’s health do occur, I will inform the club immediately. I recognise that while my child is attending club sessions where I am not present, the coaches are acting in loco parentis and may need to administer emergency first aid.
SIGNED:		DATE:

PRINT NAME:

*Data Protection Act:* Night Flyers will only use this information as necessary for the safe, efficient operation of the club. We will do our best to keep the information current and confidential. We will not knowingly disclose personal details to third parties without your permission.