Registration Form – One Voice Blackburn

Name *

First

Last

Address

Postcode

Parent's Name (if participant is under 16) *

First

Last

Parents Contact Telephone Number

Email Address *

1V Groups *

Do you (or your child) have any long term illnesses, health problems or disability that limits their activities? If yes, please use the space below to record the information.

Authorisations - I authorise the following person to collect my child from the session if I am not available *Applicable for children under 16

Name *

First

Last

EMERGENCY DETAILS

Names, Mobile Numbers and relation to child/You

PHOTOGRAPHY CONSENT *

Read Below and tick

I give One Voice Blackburn permission to use the images resulting from the photography/video filming, and any reproductions or adaptions to the images for publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity social media, press releases and funding applications