Name of parent / carer *

First Name

Last Name

Name of participant *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the participant have any disabilities? *

The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities’

Yes

No

Please also detail below any important information that BiG needs to be aware of to make your experience engaging in football sessions the best it can be *

If none please select NONE

NONE

Visual impairment

Hearing impairment

Physical disability

Learning disability

Multiple disability

Other

Please let us know how the participant will leave the programme at the end of each day *

Will be going home alone

Will be collected by parent / carer

Will be going home with another participant's parent / carer

Other arrangements

Please select all the following options where you personally consent for your child's pictures and video clips to appear on / in: *

I don't consent

On the BiG C.I.C. website

On the BiG C.I.C. instagram

On the BiG C.I.C. Twitter

On the BiG C.I.C. Facebook

On the BiG C.I.C. Youtube Channel

On the BiG C.I.C. TiKTok

In BiG C.I.C. promotion material

In BiG C.I.C. training material

All the above

Please state how your child / children will travel to and from football sessions *

In family car

Walk

Cycle

Public transport

Combination of the above

Other