SEND form | Blackwater Gymnastics

Child's First name

Last name

Gender

Male

Female

Birthday

Day

Month

Year

Address

Postcode

Parent/Guardian name & surname

Email

Emergency Contact

What conditions has your child been diagnosed with?

Does your child put 'non edible items' in their mouth (pica)?

Any physical conditions or challenges?

If your child has a history of seizures, are there any known triggers?

Briefly describe how your child communicates

What school does your child attend? (or specify if home schooled/flexi hours)

What year group are they in?

Briefly describe your child's challenges with movement

Please tick all the following that apply to your child

My child avoids swings and slides, fast movement or rides

My child likes firms hugs and squeezes

My child is generally fearful and anxious

My child is hyperactive and always on the go

My child likes to jump and crash about

My child loves to spin and swing

My child is shy and takes time to adapt to a new environment

What is the biggest challenge you and your child are facing

How can we accommodate your child best?

What do you hope to get from SEN sessions at the gym?

Any preferred class, day, time?

Do you consent for photos and videos to be taken and to be shared on our website and social media?

Yes

No

How did you hear about Blackwater Gymnastics?

I confirm to the best of my knowledge, the participant is physically fit and healthy and am aware of no other information which needs to be considered in advance to ensure that they can participate safely in physical activity.

Our training runs during school term time. Fees are calculated on 39 weeks/year and are split equally among 12 months. I agree with this.

MALDON GYMNASTICS CLUB

BLACKWATER GYMNASTICS CLUB