Test Form

Personal and Contact Details

Please enter a title. Eg Mr/Mrs/Miss
Provide any forenames as listed on your ID.
Select a date of birth.
Provide an exisiting membership number or the lead name of your outline membership.
Provide the council name of where your council tax bill is paid.

Terms and Conditions Declaration

I/ we have read and agree to be bound by the terms and conditions of the Disability Sportslink Membership above.

Parent or person responsible for the applicant should sign where necessary.

Have you signed on behalf of the applicant?

Equal Opportunities Monitoring

Sportslink is committed to developing and implementing Equal Opportunities and recognizes that discrimination occurs. (On the basis of race, religion, gender, age sexual orientation and disability.) In order to identify possible discrimination. Sportslink asks you to assist us by completing the following information.

PLEASE SELECT OPTIONS THAT BEST DESCRIBE YOU.

Gender: *
Nationality *
Sexual Orientation: *
Religion: *

Disability Monitoring

Details of a person’s disability are required to ensure that funding guidelines are adhered to as well to be able to provide a person centered approach. If you are under 18 years old or unable to understand this form, it should be completed and signed on your behalf by your parent or guardian.

Are you disabled? *
Select the expressions that you feel describes you best: *

Put a tick against the phrases that you feel describe your disability and / or health, then give all relevant details:

Bones and or joints affected?
Abnormal muscle tone?
Balance affected?
Coordination affected?
Absence of limb(s)?
Loss of use of limb(s)
Sensory Impairment?
Communication problems?
Restricts the amount of exercise?
Results in behavioral problems?
Causes seizures or fits?
History of heart problems?

Please tell us about any other details that you feel we should know about before you start on your proposed physical activity. E.g. Surgical /medical appliance or orthosis, a condition or indication not already mentioned.

I confirm that I will advise Disability Sportslink immediately if any of the information provided on this form changes in any way. I recognise that physical activities involve risk and that I, the Participant, should take all reasonable precautions and follow all advice properly given. In the absence of any negligence on the part of G.C.L.L. or G.C.L.L. staff, I accept that no liability will attach to them.

If you have completed or signed this form on behalf of the person named at the beginning of the form, please confirm your name here.