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WeAreWarriors Club
WeeAreWarriors club
Which block is your child attending?
*
Block 1 | 14th September - 19th October |P4/5 5pm-6pm | P6/7 6pm-7pm
Block 2 | 2nd November - 7th December | P4/5 5pm-6pm | P6/7 6pm-7pm
Block 3 | 8th February - 8th March | P4/5 5pm-6pm | P6/7 6pm-7pm
Block 4 | 26th April - 31st May | P4/5 5pm-6pm | P6/7 6pm-7pm
Participant Information
Participant Name
*
Participant Gender
*
Male
Female
Date of Birth
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Participant Age
*
Primary School Year
*
School Attended
*
Participant rugby club or team
Number of years playing rugby
*
Number of months playing rugby
*
Parent or Guardian Details
Parent or Guardian Name
*
Contact Number
*
Email Address
*
Address Line 1
*
Address Line 2
Town/City
*
Postcode
*
Medical Information
Doctor's Name
*
Doctor's Number
*
Doctor's Address
*
Would you consider your child to have a disability?
*
Yes
No
If "Yes", please provide details including any assistance your child may require
Does your child suffer from any medical conditions requiring medical treatment?
*
Yes
No
If "Yes", please provide details
Does your child self administer their required medication?
Yes
No
Does your child suffer from any allergies (i.e foods, medicines etc)?
*
Yes
No
If yes, please provide details
I consider that my child is in good health and capable of taking part in these activities.
*
Agree
In the event of an emergency I consent to any emergency medical / dental treatment to include the use of anaesthetics that my child may require prior to my arrival.
*
Agree
I agree to my child taking part in activities organised by Glasgow Warriors staff.
*
Agree
I agree to notify Glasgow Warriors staff of any changes to the information given on this parent / guardian consent form for the duration of the sessions.
*
Agree
I agree to my child being filmed or photographed with the possibility that these might be used for publication and/or publicity.
*
Agree
