Bugy Fit - Registration Form

Programme Information

A fitness group for parents which combines a walk around Stanley Park with fitness activities. A great way to stay in shape without needing a child minder, whilst spending some quality time with your little one.

Details

Are you an existing EitC Participant?

YesNoHave you previously registered on an EitC programme e.g. Stay & Play

Full name

Age

DOB - DD/MM/YYYY

Address

Postcode

Contact Number

Photographs may be taken during the sessions for promotional activity including in newsletters and on social media. Please select whether you consent to your / the participant’s photo being published. It may not be possible to withdraw consent once photos have been published.

YesNo

Emergency Contact Details

Emergency Contact

Parent/Guardian	Next of kin
Other

Name

Contact Number

Address (if different than above)

Terms & Conditions

• I authorise the member of staff that has a valid emergency aid certificate on site to administer any emergency medical treatment, including signing a consent form on my behalf if required by the medical services

• I acknowledge that staff are only responsible for participants whilst they are attending the session . They are however free to come and go as they please during the sessions, and staff cannot be held responsible for their welfare once they have left the site

• I acknowledge and accept that the football club or respective servants shall not have any liability in respect of any loss or damage to persons or property whilst in attendance on the applied sessions, and that members of staff reserve the right to refuse admission

If this form has not been completed, participation may be refused.

I agree to the terms & conditions above.
Signed participant

Yes

Date - DD/MM/YYYY

From time to time we would like to contact you with information relating to Everton in the Community's projects e.g. session changes (times, days etc), fixture and competition details and project evaluation surveys. If you are happy for us to do this please tick the box below. You unsubscribe at any time by notifying a member of staff or selecting "unsubscribe" on any survey.

Opt inNo thank you

A copy of Everton in the Communities Privacy Notice can be found at https://www.evertonfc.com/content/privacy. If you require further information please contact our Data Protection Officer on 0151 556 1878.

Contact Information

Male	Female
Other	Prefer not say

Arabic	Asian
Black	Chinese
Mixed	White
Prefer not to say	Other

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)

No Religion	Buddhist
Christian (All denominations)	Hindu
Jewish	Muslim
Sikh	Prefer not to say

Education	Employment
Training	None
Prefer not to say