Activity-   ………………………………….

Please mark which block sessions you would like your child to attend:

Childs Details Form - Aberdeenshire Council Sport and Leisure Activities

Participant’s name… ………………

School Attended… ……………………..Class (eg S1)…… ……

Male or Female…… ………… Date of Birth……………

Name of parent/guardian…… ………………..............

Address…………………

…………………………………………………………………………………………..

Tel nos (home, work, mobile as applicable)…

Email address …………………………………

Please give the names and contact details of two adults prepared to take temporary responsibility for your child.  They must be contactable during the session if necessary (this may include you if appropriate)

Name…… ……………………………………

Relationship to child…… ………………………………………....

Relevant Tel no. for duration of session……

Name…… …………………………………………………

Relationship to child……… ………

Relevant Tel no. for duration of session……

Please indicate how your child will be getting home from the session
□   My Child may make their own way home    
□   My child will be collected by me or another adult of whom I will inform the session leader

For activities involving water please indicate your child level of competence
□   My child is not water confident
□   My child is water confident but cannot swim 25m unaided
□   My child can swim 25m unaided

Do you consider your child to have a disability?  

□ Yes- please provide details

□ No

Please read the information below carefully and sign to say that you understand and agree with it.  If you are unable to agree to any part of it you should contact the session leader immediately.

I confirm that I am the parent/guardian with rights and responsibilities for the above named child

I confirm that I received the activity information and details accompanying this form and I understand the nature of the activity and consider my child/ward fit to take part

The activity has been risk assessed and every effort will be made to minimise risk.  Nonetheless a totally risk free environment is unrealistic and I acknowledge that a degree of residual risk remains.

I understand that Aberdeenshire Council do not provide cover for personal accident, illness, loss or damage incurred by participants.  Further, the Council’s Third Party Liability police will not necessarily indemnify participants in the events of a Third Party being injured solely due to the negligence of the participants.  The Council’s third party liability policy will, however, meet claims from Third Parties arising from the negligence of the council or its employees.  Participants wishing to obtain cover for personal accident and Third Party liability are advised to contact an insurance company or broker.

Aberdeenshire Council is committed to ensuring the safety and well being of all the children taking part in our sessions.  Given the on-going public concern on the subject of child abuse, and changes in the law, we are now required to report if we think any child has to come to harm as a consequence of possible abuse.  Where there is the possibility that a child could be at risk of abuse or neglect, Council employees are required to refer the child to Social Work, the Police or the Reporter, and under these circumstances, the parent would not normally be contacted first.

I consent to the submission of the above-named participant to emergency medical or surgical treatment including the administration where necessary, of a local, general or other anaesthetic.

I understand that in terms of the Act of Legal Capacity (Scotland) Act 1991 my child/ward may also consent to their own medical treatment if the Doctor attending is of the opinion that they understand the nature and consequences of such treatment

I understand that my child/ward must abide by the code of conduct for participants and I will support the session leader in helping my child to adhere to it.  The Code of Conduct will be explained to the children at the first session and available to view on your school or the facility website.

Photography or filming may take place during the sessions for promotion and publicity purposes: Photography may be used during the sessions. Images will be used in publications and on our website to publicise our services or celebrate special events. 
These may also appear in our printed publications, on our website, intranet, social media ie facebook, twitter and on Plasma screens in various council offices. We may also send them to the news media.
 
Please tick this box if you DO CONSENT to your child being photographed and images used as indicated above
□
 
Please tick this box if you DO NOT wish your child to be photographed and images used as indicated above 
□

Aberdeenshire Council would like to keep your details on computer to help us market classes in future
□  Please indicate if you do not want us to retain your contact details

The information given will be treated in confidence and held in accordance with the requirements of the Data Protection Act 1998

If any of the above information changes then you must inform the session leader or submit an updated form

Signed by (print name)……………

Signature……………………………………………………………………………….

Date……………………………………….

Medical Information

Recent surgery for…………………………………

………………………………………………………Date…………………………….

Any known allergy to medicine (e.g. penicillin)……… …………………………….

Is your child undergoing treatment by a doctor?  (If so, please give details)

…………………………………………………………………………………………..

Any medical condition which a doctor should know before carrying out treatment (e.g. Asthma)

…………………………… …………………………………

…………………………………………………………………………………………

Please state any restrictions you wish to place on emergency medical treatment

………………………………
Please give details of any special diets e.g. vegetarian/diabetic/no specific ‘E’ numbers etc.

……………………………… ………………………

Details of any special cultural or religious considerations that you would wish to be made.

………………………………… ………………

Any additional information

…………………………………………………………………………………………..

Name of Family Doctor ……………………

Address…… …

…………………………………………………. Tel No…

Active Schools Aberdeenshire Code of Conduct
All participants at Active Schools Aberdeenshire sessions must abide by the following code of conduct at all times. The Code of Conduct has been developed to ensure that all participants have an enjoyable time and are treated safely and fairly. We ask that all parents/guardians support us in delivering a fun and safe environment by ensuring that your child is aware of the expected behaviours before attending one of our sessions. 
At every Active Schools session expected behaviours include:-
• Be able to take instruction and follow direction from the session coach
• Not behave in a manner that negatively affects others enjoyment
• Understand that they may not physically or verbally hurt others, and they will respect the
feelings, safety and personal integrity of themselves and others
• Respect any equipment or another participant’s property.
By signing your child up to Active Schools Aberdeenshire sessions you are accepting our Code of Conduct. Failure of your child to follow our Code of Conduct and display any unacceptable behaviour will result in the following sanctions:
Minor Behavioural Issues
Stage 1		Spoken to by the coach about their behaviour
Stage 2 	Time out – time out on the side to reflect on their behaviour before being spoken to by a coach about their behaviour and returning to the session
Serious/Repeated Minor Behavioural Issues
Stage 1	Time out – time out from the session and spoken to by the coach/Active Schools Coordinator, who will issue a behaviour management form to the parents at the end of the session. In severe instances parents/guardians will be contacted immediately to collect their child. They will be welcomed back at the next session under the condition that there is an improvement in behaviour. 
Stage 2	If on return they continue to display poor behaviour which affects the enjoyment of sessions for other participants, they will be excluded from all future activities, and your Active Schools Coordinator will be in touch to explain the decision.