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To be completed by or on behalf of the Participant. It should be checked thoroughly by a duly authorised parent, guardian or carer.
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    PARTICIPANTS DETAILS

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    PARENT OR GUARDIAN DETAILS

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    SOME OTHER INFORMATION

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    DISCLAIMER AND MEDICAL STATEMENT

    It is important for the welfare and safety of the participants that you declare all medical conditions and information. In most cases it will not prevent the individual from participating but will allow us to provide suitable support for their needs.
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    PLEASE NOTE:

    * Staff are not permitted to take responsibility for or to administer medicines. You are therefore responsible for ensuring any medicine is available and taken correctly. * You understand that whilst involved in the programme activities the participant will be under the care of the community trust staff and other suitably approved adults. Whilst we will take all reasonable care of participants you acknowledge that in the absence of our negligence, participation in the programme is at your sole risk and that we shall not be liable for damage or injury arising from activities. In the unlikely event of an accident occurring, you provide your permission for a designated representative of the community trust to authorise emergency medical treatment, including the use of anaesthetic if deemed necessary.
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    TRAVEL AND COLLECTION STATEMENT

    * During the programme the participant will be responsible for getting to and from the agreed venues, and will be allowed to leave without collection. * For the residential venues or where transport facilities are provided as part of the project, the participant will be responsible for getting to and from the designated meeting location. Participants will not be allowed to leave other than from that location, but will be permitted to leave from that location without collection. * During the activities, for example as part of a Social Action Project, the participant may be required to undertake travel unsupervised, either on foot or by public transport. You give us permission to allow the participant to leave designated locations (other than the residential or supervised trips) without collection, and to undertake some travel unsupervised.
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    EMERGENCY CONTACT DETAILS

    In case of an emergency, who should we contact?
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    FURTHER INFORMATION

    To receive further information about Pompey in the Community and related activities or Portsmouth Football Club please provide a mobile number and / or an email address.
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    Please note:

    To cancel your booking please contact us via email, phone or post explaining you would like to cancel. In some circumstances refunds will be issued but this will be entirely at our discretion.
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