Participant Name Address (First Line) Town Date of Birth Home Tel No: Mobile No: E-mail Address (Required for communication) Emergency Contact Information Please provide a minimum of 3 contacts Name Relationship to participant Home No. Mobile No. Additional Info Medical Information (Please provide anything relevant that does/may affect participation in sport. Please also include any information that may be required in an emergency) Disabilities and Additional Needs Please provide information that will enable us to support the participant in their sports session. This can include physical, learning, behavioural, sensory or communication needs. Data Protection County Postcode Doctors Surgery Details The information on this form shall not be shared with any third party organisation without further consent. The contact information you have provided will be used to contact you with offers and activities associated with Bounce and Cheer Education CIC only. I agree to the terms on photography and data protection Photography BACE has an 'Opt out' option for photography. If you would like to activate this, please fill in the 'Photography Opt Out' form. Details of our photography consent information are displayed in reception and our website: Name of person submitting form Relationship to participant