By ticking yes and signing this form you are confirming that you acknowledge the declaration statements outlined below and consent to participation of Active Lichfield Communities activities.

Home Arrangements
I am aware that if I give permission for my child to make their own way home, that once my child leaves a session, they are no longer under the supervision and care of session staff.


Information Declaration
I can confirm that I understand the above and the information provided on this form is correct to the very best of my knowledge. It is my responsibility to seek the advice and approval of my doctor before undertaking regular exercise.


Data Declaration
By submitting this form, I consent to Lichfield District Council processing my ordinary and special personal data for the purposes outlined in the privacy notice on the Active Lichfield Website (www.activelichfield.co.uk/volunteer-for-getin2it-2/privacy-notice/)


Medical Declaration
I confirm that all medical information given is correct and up to date.

I understand & consent given that, in the event of any illness/accident, any necessary emergency treatment can be administered and that staff/volunteers cannot be held responsible for any loss, damage or injury suffered to the participant.

I understand that medicine cannot be administered to participants. If Medication is required this should be disclosed and administered by a parent/guardian or self- administered by the participant.

Failure to disclose any medical information may cause a delay in treatment prior to emergency services attending and Active Lichfield reserve the right to refuse participant attendance at sessions.


Consent to Participate
I acknowledge that by signing this form I am giving consent to participate in Active Lichfield Communities sessions.