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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 Your privacy is important to us. For more details about how we use your personal data, please read our Privacy Statement. BACE would like to share information about their programmes and sessions with you. Please select the boxes below to agree to receive this information. By ticking the boxes you consent to receive our programmes and other communications from us about our services, promotional activities and events, By ticking this box I agree to the terms of Photography including the appropriate use of photography for BACE promotional purposes. Photography BACE has an 'Opt out' option for photography. If you would like to activate this, please fill in the form. Please understand that by opting out of photography consent we may ask you/your child to not be involved in team and club photos etc. Name of person submitting form Relationship to participant 'Photography Opt Out' *Please complete either the tick box below or the “Photography opt out form” by email by telephone communications You may opt out of receiving these communications at any time by emailing We will not pass your details to third parties.