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LITTLE KIHITTERS REGISTRATION FORM (Ages 5-11)

To secure your child’s place in the Little KiHitters boxing programme as part of Activate Body and Mind, a fully completed registration form must be submitted before they can attend. This must be completed by a parent, guardian, responsible adult, or listed emergency contact.

 

⚠️ Please note: Incomplete forms may delay your child’s registration and could result in them missing out on a place.

 

Once your form is received and your place confirmed, your child will be enrolled for the entire next school term.

 

Thank you for helping us keep your child safe, supported, and ready to take part!

YOUNG PERSON DETAILS
Gender
Gender
Gender
Does the child /young person have any medical conditions we need to be aware of?
Does the child / young person have any allergies we need to be aware of?
Does the child / young person have any SEND or additional needs we need to be aware of?

Activate Body and Mind take photographs / videos of children who attend our events / programmes to be used in our group publicity (including our social media pages, website, and any promotional material to support and promote future events and to help us continue to deliver free camps). Once we no longer need images for publicity purposes, we will delete them. Does Activate Body and Mind have permission to include your child/ren?

*Consent can be withdrawn at any time by emailing us at info@activatebodyandmind.co.uk If consent is withdrawn, we will delete the photograph or video and not distribute it further.

We’d love to keep in touch and provide you with details of our future programmes and events. If you

are ok for us to email you in the future, please add your email address below:

Informed Consent and Acknowledgement - I give permission for my child to participate in Little KiHitters organised by Activate Body and Mind, including all the activities involved. I understand that although staff or leaders in charge of the project/activities will take all reasonable care of participants, they cannot be held responsible for any loss, damage or injury my child suffers as a result of the event.

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Consent to Emergency Medical Treatment - Activate Body and Mind will contact you before the commencement of any medical treatment, should this be necessary, unless your child's condition is such that immediate treatment is required before contact with you can be made. Please check the box below to confirm you authorise Activate Body and Mind to consent to any X-ray, examination, anaesthetic, diagnosis, treatment, and/or hospital care that may be recommended for your child/ren by a licensed physician.

I understand that my child needs to follow the behaviour code and any safety rules so that Activate Body and Mind can keep them and other children safe.

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Please note that parents/guardians will be contacted to pick up their child/children before the end of the session should they use inappropriate language or violence towards staff or other children

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Please confirm you are accepting of the above information by acknowledging and signing below.

PARENT / GUARDIAN / CARER EMERGENCY CONTACT DETAILS
MEDICAL CONDITION DETAILS
ALLERGY HISTORY / INFORMATION
ADDITIONAL NEEDS
PHOTOGRAPH / IMAGES DISCLAIMER
MARKETING CONSENT

ACTIVATE YOUR POTENTIAL

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