Apollo Active NW Christmas Camp Registration Form

Child Information

Child's Name*

First NameLast Name

Child's Date of Birth*

DayMonthYear

Gender*

MaleFemaleOther

Home Address*

Street Address

Street Address Line 2

CityCounty

Postcode

What school does your child attend?*

Please provide details of any allergies, dietary requirements or medical conditions your child has. If the child has medication (e.g. inhaler / EpiPen) please let us know in your answer. *

Does your child have any additional needs that may impact their participation (e.g. disabilities, special educational needs, etc.)*

YesNo

If you have chosen yes, please provide details below

Does your child require 1 to 1 support?

YesNo

Please describe any modifications or adaptations that your child may need.

Parent/Guardian Information

Name*

First NameLast Name

Contact Number*

Email*

example@example.com

Relationship to the Child*

Emergency Information

Name*

First NameLast Name

Emergency Contact's Number*

Booking Information

Is your child entitled to benefits-related free school meals? Please note, this is checked by the local authority.*

YesNo

Please select the weeks you would like your child to attend. Please note, camps will run from 9am - 1pm:

30th December31st December1st January2nd January

Please highlight the sports/activities your child enjoys participating in:*

For promotional purposes only, do you give consent to your child being present in Apollo's photos and videos?*

YesNo

Due to the demand for these courses, we will allocate places on a first-come, first-serve basis. Should you be assigned a place, an email will be sent to you on 17/07/2024. To confirm your place, we will need to get a response from you within 3 days of that date. If we do not receive confirmation by then, your place will be allocated to someone else. Please tick below to confirm you understand this.*

I understand

Informed Consent and Acknowledgement
By submitting the form, I acknowledge that all information provided in this form is accurate. I hereby give my consent for the child's participation in all activities prepared by Apollo Active CIC during the selected camp(s). I assume all risks and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Apollo Active CIC and all its respective representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I give my consent to Apollo Active CIC staff to administer first aid on site if needed. I acknowledge that the Apollo Active CIC staff will take the best course of action and necessary steps to ensure the safety and wellbeing of my child. In the event of injury, I hereby waive all claims against Apollo Active CIC, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Apollo Active HAF Camps - Christmas 2024: Hale Village