Client Registration for Under 18s

Name of Child/Young Person *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Number *

Please provide the best number to contact you on in case of an emergency.

(###)

###

####

Second Contact *

Please provide the name and contact number for a second person who we can contact in case of an emergency. This will only be used if we are unable to reach the main emergency contact.

First Name

Last Name

Phone Number for Second Contact *

(###)

###

####

Does your child have special educational needs and/or a disability? *

Yes

No

Does your child have an EHCP? *

Yes

No

Does your child have (or have they ever experienced) any of the following? *

Please tick all options that apply.

High or low blood pressure

Elevated blood cholesterol

Diabetes

Chest pains brought on my physical exertionn

Childhood epilepsy

Dizziness or fainting

A bone, joint or muscular problems with arthritis

Asthma or respiratory problems

Any sustained injuries or illness

Any allergies

None

Does your child take any medication? *

Yes

No

Has a doctor ever advised against your child exercising or is there any other reason why your child should not participate in physical activity? *

Yes

No

Photo and Video Consent *

From time to time, we use photos and/or videos from client sessions for education and marketing purposes, including social media, website and printed materials. Please tick the boxes below if you consent to us using your child's photos and/or videos for each purpose. You may withdraw your consent at any time by emailing us at contact@gtfitnessandwellbeing.co.uk. I consent to my photos and videos of my child being used for:

Education purposes (to aid your child's understanding of their own movement)

Marketing purposes