Participant Details

First Name (required)

Last Name (required)

Date of Birth (required)

Gender (required)
—Please choose an option—MaleFemaleNon-BinaryPrefer Not To SayOther

Street (required)

City (required)

Postcode (required)

Name of School (required)

Parent/Guardian/Carer Details

Contact's First Name (required)

Contact's Last Name (required)

Contact's Phone Number (required)

Contact's Email

Emergency Contact Details

Emergency Contact First Name (required)

Emergency Contact Last Name (required)

Emergency Contact Phone (required)

Relationship to Emergency Contact (required) —Please choose an option—ParentSpousePartnerCousinAuntUncleGrandparentGrandchildFamilyOther

Additional Information

Are you a family with a disabled adult or child? (required)
—Please choose an option—YesNo

Are you a family with a young mother under 25 years old? (required)
—Please choose an option—YesNo

Are you a family with a lone parent? (required)
—Please choose an option—YesNo

Are you a family with 3 or more children? (required)
—Please choose an option—YesNo

Do you consider yourself an ethnic minority family? (required)
—Please choose an option—YesNo

Please select which of the following your family has experience of: (required)
—Please choose an option—NoneCare ExperiencedSubject to Kinship or a Guardian OrderExperienced Trauma

Will your child attending Community Games have an affect in the following ways? (required)
—Please choose an option—Maintain employment (you or household)Increase working hoursAccess employability advice/servicesRespite from caring responsibilitiesnone

Please provide any additional information you think might be helpful to Celtic FC Foundation staff

How did you hear about the project?
—Please choose an option—WebsiteSocial MediaFamily/FriendCeltic FC Foundation Open DayReferral AgencySocial WorkerSchool/Education ServicesOther

Have you previously attended any projects through Celtic FC Foundation?
—Please choose an option—YesNo

End Of Session

A responsible adult will be required to drop off and collect your child at the end of each session. Please provide the names of the people authorised to do so: (required)

Medical Details
I consent to any emergency medical / surgical / dental treatment which the child may require during the course of the activity.

Does the child suffer from any conditions requiring medical treatment on a regular basis? (required)
—Please choose an option—YesNo

Is the child allergic to any medication, or has he / she any other allergies? (required)
—Please choose an option—YesNo

Has the child received a tetanus injection in the last five years? (required)
—Please choose an option—YesNo

To the best of your knowledge, has the child been in contact with any contagious or infectious diseases or suffered from any in the last three months that may be or become contagious or infectious? (required)
—Please choose an option—YesNo

I agree to inform the worker in charge as soon as possible of any change in medical circumstances between the date of signing and commencement of the activity.

Details of Family Doctor

Doctor's Name/Name of Practice

Doctor's Address

Street

City

Postcode

Phone

Activity Waiver

By ticking the boxes below, you give permission for your child to participate in off-site activities organised by Celtic FC Foundation. These activities may include travel on foot or in supervised vehicles.

Please tick the activities you are happy for your child to attend. Specific details will be provided in due course.

Tuesday 14th - Cinema Trip to Showcase Cinema

Wednesday 15th - Bowling at Hollywood Bowl

Thursday 16th - Sports at Emirates Arena

Consent

I confirm the above information is accurate and I will notify Celtic FC Foundation of any changes.

Tick to confirm we can use personal details to inform you of Foundation news and events?

Please note that video or still photographs may be taken during the project which may be shared with funding partners and/or used in future marketing materials such as, but not inclusive to Celtic FC Foundation website, Celtic View, Celtic website or Celtic TV. Do you consent to this? (required)
—Please choose an option—YesNo

For full details on how your data is used and stored please contact Celtic FC Foundation by emailing [email protected] or by obtaining a copy from one of our Foundation coaches.

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