Street League Referral Form

Please complete the form below

Referrer Details
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Forename must be provided
Surname must be provided
Gender must be provided
Date of birth must be provided
Postcode must be provided
Contact number must be provided
How did you hear about Street League? must be provided  Select only one How did you hear about Street League? 
How did you hear about Street League?
If there is a specific Street League site or staff member you would like to be referred to, please note in the box below.
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Signature must be provided

* Participant Statements


Media Consent

By registering for and participating in Street League programmes, I hereby grant Street League and its affiliates the right and permission to use, reproduce, distribute, and display any photographs, videos, audio recordings, quotes, or other media content captured during my involvement in Street League activities. I understand and agree that this media content may be used for promotional, educational, and informational purposes, including but not limited to, social media, websites, marketing materials, reports, and other publications. Street League reserves the right to edit, modify, or otherwise alter the media content at its discretion. I acknowledge that I do not own copyright or have any rights of ownership or other claim over the images, videos, or other pieces of content in which I may appear in relation to Street League.

If I do not wish to grant this media consent or wish to withdraw consent at any time, I understand that it is my responsibility to inform Street League in writing by contacting info@streetleague.co.uk.

I agree that I have read, understood, and give my informed consent to all of the above information contained within the Media Consent Statement.

Marketing Consent

I hereby give Street League permission to use my details on file to contact me about future marketing opportunities.

If I do not wish to grant this marketing consent or wish to withdraw consent at any time, I understand that it is my responsibility to inform Street League in writing by contacting info@streetleague.co.uk.

Personal Data Declaration

I understand that when I register for and participate in Street League programmes, my personal data (including sensitive data such as information about my gender, ethnicity or health) may be processed in accordance with Street League’s legitimate interests and in line with Street League’s Privacy Notice.

I agree that I have read and understood Street League’s Privacy Notice.

Liability

I confirm that:

1. No liability shall arise or occur against Street League for any loss, damage or theft of personal property belonging to me, whilst participating in any Street League activity.
2. No liability shall arise or occur against Street League for any death or injury occurring whilst participating in Street League activity, except to the extent that such injury or death was the result of a negligent act or omission of Street League, could have been reasonably avoided, and was foreseeable.
3. I am in good physical condition and capable of engaging in the level of exercise associated with sporting activity. Exercise will not be detrimental to my health, safety, comfort or physical condition.
4. I have no condition which may be aggravated by my participation in a sporting activity or would make it inadvisable to participate in a sporting activity.

I agree that I have read, understood, and give my informed consent to all of the above information contained within the Liability Statement.
Do you agree to the data protection terms and conditions?
Client:
Date: ......................... Signed: .......................................
Caseload:
Date: ......................... Signed: .......................................