Register

Please fill out the form to register an individual for activities at the Game Change Project.

Registration Form

Referred By:

Organisation:

Please note that the information on this form is for the use of the Game Change Project and is not available to any other individuals or groups. This means that we will not disclose your email address, mobile number or any other details to another individual without your permission.

Details of Young Person

First Name

Surname

Date Of Birth

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January Febuary March April May June July August September October November December 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Address

Line 1:

Line 2:

Town:

County:

Postcode:

Telephone:

Sex / Gender:

Male

Female

Non Binary

Emergency / Parental Contact Details

In the event of an emergency relating to the participant please provide information below which we can use to contact you.

Adult Emergency Contact Name

Relationship

Contact Telephone Number/s

Email Address

Medical Information

Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness etc.) which we should be aware of?

Diet

Please give any details of special dietary needs we should be aware of (e.g. food allergies):

Behaviour

Please give details of any behavioural/emotional needs we should be aware of:

Activities

Please check which modules are of interest and indicate level of experience (if any):

Machine Operating / Basic Mechanics

Experience Level:

None

Limited

Good

Equine Handling

Experience Level:

None

Limited

Good

Rural Skills

Experience Level:

None

Limited

Good

Marketing

We may take photographs and videos of activities. These images may be used for promotional purposes. If you do NOT wish for your son/daughter to be photographed please tick this box:

Consent

I agree to my son/daughter participating in The Game Change Project and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child.

I accept and support the code of conduct for behaviour. I realise and accept that in the event of my child’s behaviour adversely affecting the safety of the activity, the organisers reserve the right to return my child home.