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Name of Event/Detail

A. PARTICIPANT’S DETAILS

First Name:

Surname:

JG Membership Number:

Date of Birth:

Address:

Postcode:

Home Telephone Number:

Mobile Telephone Number:

Email Address:

B. PARENT/LEGAL GUARDIAN/CARER DETAILS

First Name:

Surname:

Relationship to child:

Address:

Home Telephone Number:

Mobile Telephone Number:

Email Address:

C. PHOTOGRAPHS, IMAGES AND VIDEOS

I, the undersigned, by ticking the box below, hereby grant or deny permission to The Arsenal Football Club PLC and all of its associated companies (the “Club”) to use photographs, images and/or videos of the child named in Section B (the “Imagery”), in all media now existing or invented in the future, on a worldwide basis and in perpetuity. Uses include the display, distribution, publication or other use of the Imagery taken during the Activity. I agree that the Imagery may be (i) used by the Club and its associated companies for any purpose (including but not limited to marketing and/or promotional use) or (ii) provided to a third party for its purposes (including but not limited to marketing and/or promotional use). I understand that my child’s full name, if aged under 16, will not be listed in conjunction with the Imagery unless explicit consent is sought.

Grant permission

Deny permission

D: INDIVIDUAL NEEDS

I, the undersigned, provide the below information in relation to the child named in Section B to assist Arsenal Football Club with the performance of the Activity, to ensure that the child’s individual needs are considered (please tick as appropriate):

Dietary & Allergies

Disability & Access Needs

Medication

Religious & Cultural Needs

Details:

Provide details here, e.g. times medication must be taken, if help is required to administer medication, additional religious/faith needs and access needs.

Name:

Relationship to child:

Address:

Post Code:

Home Phone Telephone Number:

Mobile Telephone Number:

Email Address:

PRINT NAME of Parent/Legal/Guardian/Carer: