Bristol Flyerz

The information you enter into this form will be collected and stored by Access Sport. Tick the tickbox below to confirm you understand (required)

I understand

Name of Parent

Participant First Name (required)

Participant Surname (required)

What do you/ your child hope to gain from attending Flyerz sessions? Please tick all that apply

To make new friendsTo do new thingsTo have funTo develop confidenceTo be activeTo learn new thingsTo be healthierTo meet new peopleTo play sportOther

Gender (required)

MaleFemaleTransgenderOtherPrefer not to say

Date of Birth (required)

Ethnicity (required)

WhiteAsianBlackMixedOtherPrefer not to say

Postcode (required)

What type of school do you/your child attend?

MainstreamSpecialOther

Email Address (required)

Emergency Contact Number (required)

I give permission for images/footage to be taken of me whilst taking part. I understand that the images/footage may be used to promote the work of Access Sport, for example on our website or in authorised publications (required)

I give permission as the participant (over 18 only)I give permission as the parent/carer/guardianI do not give permission

Do you/your child have an impairment or long term health condition? (required)

YesNo

Do you/your child have difficulties with any of the following? (required)

VisionHearingLearningCommunicationMental HealthPhysical Movement/ControlOtherNone

Please provide further details to enable the coaches to best cater for your needs.

Do you participate in sport and/or physical activity, outside of school or work?

YesNo

Have you taken part in 30 minutes of sport and/or physical activity, outside of school or work, at least once in the past 4 weeks?

YesNo

How did you hear about Flyerz Hockey? If through Social Media, please list which page/organisation

Would you like to sign up to the Access Sport Ignite Bristol newsletter that will provide information on all the latest disability inclusive sport opportunities in the local area? We will not share your contact details with any third party organisations.

YesNo