Christ Church Amateur Boxing Club | What's on | Crystal Palace Community Trust

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Name (of person accessing services/activities)

Date of birth

Sex

Male

Female

Prefer not to say

Name of parent/carer if person is under 18 years old

Telephone number

Address

Postcode

How would you describe your ethnic status

This information is required by external funders who contribute to the cost of services/activities that we deliver.

Emergency contact 1: name

Emergency contact 2: name

Emergency contact 1: relationship

Emergency contact 2: relationship

Emergency contact 1: telephone

Emergency contact 2: telephone

Disclaimers

I understand that during courses/activities run by the CPCT and Partner organisations, photographs may be taken of me/my child for promotional purposes. I give permission for these photos to be used in social media and hard copy promotional materials.

Permission to take part

I consent (for my son/daughter/ward*) to take part in the above activity. I am fully aware of the type and extent of the activity.

NB If the participant is sick within the 24 hours prior to the activity, they cannot take part.