Mental Health Football - Registration Form
Newcastle United Foundation respects your privacy and is committed to protecting your personal data. We will inform you as to how we look after your personal data when you participate in one of our programmes and tell you about your privacy rights and how the law protects you. Our privacy policy aims to give you information on how Newcastle United Foundation collects and processes your personal data. It is important that you read and consent to the privacy policy together with any other privacy policy or fair processing policy we may provide on specific occasions when we are collecting or processing personal data about you so that you are fully aware of how and why we are using your data. The privacy policy supplements other notices and privacy policies and is not intended to override them. Please read our Participant Privacy Policy linked below: https://www.nufoundation.org.uk/privacy-and-cookies If you have any questions about this privacy policy or our privacy practices, or would like to exercise your legal rights, please contact us in the following ways: Email address: Foundation@nufc.co.uk Postal address: NUCASTLE Diana Street Newcastle upon Tyne NE4 6BQ
I consent to Newcastle United Foundations Privacy Policy.
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No
Yes
Contact Information
Forename
Surname
Date Of Birth
Day
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1911
1910
Mobile
Email
Photo/Filming Consent
Please Select
Yes
No
Prefer not to say
Demographic
Gender
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Female
Male
Non-binary
Other
Prefer not to say
Transgender Female
Transgender Male
Other
Ethnicity
Please Select
Asian/Asian British - Indian
Asian/Asian British - Pakistani
Asian/Asian British - Chinese
Asian/Asian British - Bangladeshi
Asian/Asian British - Other
Asian/Asian British - (Unspecified)
Black/African/Caribbean/Black British - African
Black/African/Caribbean/Black British - Caribbean
Black/African/Caribbean/Black British - Other
Black/African/Caribbean/Black British - (Unspecified)
Mixed/multiple ethnic groups - White and Asian
Mixed/multiple ethnic groups - White and Black African
Mixed/multiple ethnic groups - White and Black Caribbean
Mixed/multiple ethnic groups - Other
Mixed/multiple ethnic groups - (Unspecified)
White - Welsh/English/Scottish/Northern Irish/British
White - Irish
White - Gypsy, Roma or Irish Traveller
White - Eastern European
White - Other
White - (Unspecified)
Other ethnic group - Arab
Other ethnic group - Other
Prefer not to say
Disability
Please choose a value
Yes
No
Prefer not to say
Disability - please state
Hearing impairment (deaf or hard of hearing)
Learning difficulty (e.g. movement co-ordination difficulty (Dyspraxia, Dyslexia, etc.)
Learning impairment/disability (eg. Down's syndrome, etc)
Long term illness (eg. cancer, HIV+ etc)
Mental health condition (eg. depression, schizophrenia etc)
Physical impairment - ambulant (I do not use a wheelchair)
Physical impairment - wheelchair user
Social/communication impairment (eg. autistic spectrum disorder, Asperger's syndrome etc)
Visual impairment (blind or partially-sighted)
Other
Prefer not to answer
Address
Address line 1
Address line 2
Town
Post Code
Medical Information
In the event that I get injured while attending a course or activity, I give my consent to receive medical attention.
Please Select
Yes
No
Not Given
Do you have any medical conditions or require medication to safely participate in a session?
Please Select
Yes, I have a medical condition and require medication
Yes, I have a medical condition but do not require medication
No, I do not have any medical conditions or medication requirements
Prefer not to say
Other
What medical condition do you have?
Please Select
ADHA
ADHD
Allergies
Anxiety
Asthma
Brain Injury
Cancer
Cancer1
Chrons
DVT
Dementia
Depression
Diabetes
Epilepsy
Functional Neurological Disorder
Hiatus Hernia
High blood pressure
Marfan Syndrome
None
Osteo Arthritis
Other
Prefer not to say
Schizophrenia
Do you take any medications that you think we should know about (for a disability or medical condition) that might impact your participation in this programme?
Do you have any access requirements that we need to be aware of?
Emergency Contact Details
Emergency Contact Forename
Emergency Contact Surname
Emergency Contact Mobile
Emergency Contact Relationship to Participant
Declaration
I confirm that I have provided consent to take part in this programme
Please Select
Yes
No
The information provided in this form is to the best of my knowledge and is accurate
Please Select
Yes
No
Newcastle United Foundation would also like to obtain photography and videography for evaluation and publicity purposes - Please tick below the additional information you are happy to consent to.
I provide consent for my images to be used for evaluation and publicity.
I provide consent for my images to be shared with Newcastle United Football Club.
I do not consent
I provide consent for images being used for reporting only.
Do you give consent for Newcastle United Foundation to send you news and updates to your registered email address?
Please Select
Yes
No
Submit
