Parent's Name (required)

Parent's Email (required)

Parent's Telephone (required)

Child(s) Name (required)

Child(s) Age (required)

Do you give consent for your child to be photographed for promotional purposes?

Please select...YESNO

Does your child have any allergies or dietary requirements?

Does your child have, or have they ever been told they have any health/medical conditions or concern?

Is there any family history of health conditions?

Has your child had any muscular bone or joint pain whilst exercising within the last 12 months?

Please select...YESNO

Has your child been hospitalised within the last 12 months?

Please select...YESNO

Does your child ever suffer from dizziness that results in a loss of consciousness or falling over?

Please select...YESNO

Does your child ever get chest pains?

Please select...YESNO

Does you know of any other reasons preventing or affecting your child's participation in exercise?

IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE GIVE FURTHER INFO HERE:

In order to help us understand what resources are needed in our sessions, we would be grateful if you could let us know what you are most looking forward to gaining information on:

Budget Advice?

Please select...YESNO

Healthy eating?

Please select...YESNO

Food Shopping?

Please select...YESNO

Fussy Eaters?

Please select...YESNO

Nutritious Meal Planning?

Please select...YESNO

Basic Cooking Skills?

Please select...YESNO

Reading Food Labels?

Please select...YESNO

Snacking Choices?

Please select...YESNO

By completing this form I agree to the terms and conditions of use at RVHWP and understand that they may contact me via email, SMS, telephone or post for the purpose of delivering the services to me. The information collected on this form (including but not limited to my personal data) will be used by RVHWP and third parties approved by RVHWP to enable the delivery of services.

Please tick the box if you would like to receive information on Roefield Leisure events, activities and promotions.

By ticking this box I agree that RVHWP and third parties approved by RVHWP and acting on its behalf may contact me via email, SMS or post, using the personal data I have provided on this form, with information on events, activities and promotions.

If you wish to unsubscribe from future email communication regarding RVHWP events, activities and promotions please send an email to sport@roefield.co.uk and add "RVHWP Unsubscribe" to the subject line.