To save time, please complete the below form and either print it or email it back to us at:

Creative Performance Ltd 

Information & Parental Consent Form

Activity or Project:                                                       Date:
Name of Child: Surname:
Address of Residence

And Contact Telephone Number

Post Code:                                 Telephone Number:
Date of Birth        /         / Age Male




School you

 go to




Name of class teacher

Contact For Parent/Carer

In Case of Emergency





Medical Information
GP’s Name Address &

Tel. Number

 Post Code:                               Telephone Number:
Please give the date of last Tetanus Injection if known
Please tell us about:

  • Any Dietary requirements 
  • Medication taken regularly
  • Disabilities 
  • Special educational needs
  • Behavioural fits
  • Allergies (e.g. penicillin) 
Ethnic Origin (Please Tick One Box Only)
Asian or Asian British Mixed Heritage White Black or Black British
Bangladeshi White & Black Caribbean British Caribbean
Indian White & Black African Irish African
Pakistani White & Asian European Black Other
Chinese Other Mixed Heritage White Other 
Asian Other
Other Ethnic Group

(Please State)

Not Known/Prefer Not To Say

Please read the following information & sign below

(A copy will be given to all parents/carers & members)

  • I give my consent for the person named on this form to attend Creative Performance and for him/her to take part in activities on and off site during advertised session hours. I will ensure that my child understands that any rules and instructions given by staff must be obeyed at all times.
  • I undertake to inform the Leader in Charge of any changes in the fitness of my child, which may affect any activities they take part in. I give consent for those in charge to give permission for my child to receive medical treatment in case of emergency, but only in the event that I cannot be contacted or present in time.
  • I agree that if the person named on this form is responsible for any act, which damages the club premises or equipment, either individually or jointly with others. I will accept liability for the costs involved to remedy the damage, in proportion to the degree of involvement of my child causing the damage.
  • I understand that from time to time Creative Performance may photograph or video events & activities for use in promoting the organisation or satisfying funding bodies that activities have taken place. I give consent for these images to be used for these purposes only.

Signed: (Parent/Carer) Date:

Your Email Address is:- 

Young Persons Contract

I agree:

  • To show respect and courtesy to other members of the club and the staff of Creative Performance, both on and off site and to obey and instructions given by staff in relation to my safety.
  • To show respect to the club equipment, premises and the surrounding area. I understand that I will be responsible for any damages I caused as a direct result of vandalism.
  • To keep the centre tidy during each session and assist staff in clearing up.

Failure to abide by this contract may result in members being barred for a period of time and parents or carers being notified.

Signed: (Member of Club) Date: