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Health Waiver & Consent Form

First name of Adult/Parent

Last name of Adult/Parent

Name and date of birth of participant

Select an Address

Email

Phone

Emergency Contact Details

Please specify anything we should know about: Health conditions / Allergies / Etc.

You understand that this is a full contact activity, and that you may be at risk of injury?

Photography & Filming: Please UNTICK if you DO NOT give us consent to take/use media of you or child in your care.

I accept terms & conditions

Your Signature

Thanks. We look forward to seeing you soon!

SPECIAL THANKS TO OUR PARTNERS & SPONSORS

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OPENING HOURS

Sunday: 10:00 - 14:00

At Caxton Hall Community Centre, E3 2EE

Wednesday/Friday: 16:00 - 20:00

At St Paul's Church Old Ford, E3 5JL

POLICIES

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Eqaulity & Diversity

CONTACT

contact@radojunkie.com

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