The information requested be for the safety and wellbeing of the participants, please answer all questions truthfully and accurately as possible. Please inform Team Scenario, in writing, if any changes occur to the information given.


Please Complete in BLOCK CAPITAL letters

Accommodation Status: *
Telephone number(s): *
Gender: *
Are you in: *


What is your ethnic group? Choose one from the following sections and tick the appropriate box. Categories provided by the Home Office & CRE



Asian or British Asian:

Black or Black British:

(If not English)



We do not exclude because of medical needs. However it is essential that we have full details in order to offer the best standards of care

Do you have?
Are you currently being prescribed any medication? *

(If YES please state details. i.e. times to be taken, dose etc.)
Have you been in contact with or had any contagious or infectious disease in the last four weeks? *

(If YES then please give details)
Have you had a tetanus injection in the last 5 years? *

(If YES then please give details)



Do you consider yourself to have a disability? *

Do you require one to one support / assistance? *

(eg: Visual Impairment, Physical Disability, Multiple Disability, Hearing Impairment, Learning Disability or Other)


In case of an emergency during the activity, please could you write down two contact names, addresses and telephone numbers?

Contact 1 * Contact 2 *
Name: *
Address: *
Telephone – Home: *
Telephone – Work: *
Telephone – Mobile: *


Please tick & initial next to the activities you agree for the person named above to participate in:



I consent to the person named above participating in Team Scenario activities, as described above. I also consent to the person named above being escorted by Team Scenario to and from activities on the programme, by vehicle both public and private and as a pedestrian. I recognise that the accompanying staff will be responsible for their supervision and care as far as can be reasonably expected. I understand that they will not be constantly supervised. I acknowledge the need for mature and responsible behaviour of the person named above and I believe that this can be expected of them.

I agree to inform Team Scenario in writing, as soon as possible of any changes to medical circumstances of the person named above either prior to or during the programme. I agree that in an emergency TEAM SCENARIO or its representatives may authorise medical treatment for the person named above including anaesthetic, if it is not practicable to consult me first. I will indemnify TEAM SCENARIO and its representatives, agents and employees in relation to acting in ‘’loco-parentis’’ in the case of medical emergencies only.

I agree to indemnify TEAM SCENARIO its representatives, agents and employees, from all liabilities in relation to loss or damage suffered or caused by the person named above or which result from the person named above failing to follow any reasonable instructions given to them other than loss or damage resulting from the negligence of TEAM SCENARIO or their representatives.

I understand that photographs, audio and visual recordings of the participant engaged in TEAM SCENARIO activities may be used for promotional or other materials, such as websites, local and national media. I hereby give irrevocable permission for this. I agree that I and the participant shall have no right to the recordings and all recordings belong to the Team Scenario Organisation.

I understand that the information given may be kept on a computer database, which will only be accessed by Team Scenario. I confirm that I agree with the above declaration and the information on this form is complete and accurate to the best of my knowledge.

(Please note TEAM SCENARIO, its agents, employees and representatives cannot be held responsible for the loss or damage to participant’s property and TEAM SCENARIO reserves the right to refuse participation of any person if there are concerns raised by the response on this form, especially if it’s due to misbehaviour of the young person.)