Healthy Holidays Registration Form 
This form must be filled in by a parent/carer /guardian 
Forename Surname 
Date of Birth D D M M Y Y 
Address Community Hub 
you would like to 
attend. 
Slung Low - Holbeck 
Postcode 
Emergency Contact 
Name and number 
E-mail Address 
Relationship to the 
young person 
School 
If your child is under the age of 8 years old they will need to be accompanied by an appropriate adult (18 year 
old and over) for Ofsted requirements. This is only of the librarian part of the programme (2 days) 
Which of these best describes their gender identity? 
Male Non-Binary Female 
Other (please 
describe) 
Ethnic Origin: 
Asian or Asian 
British 
Bangladeshi 
Indian Kashmiri 
Kashmiri 
Pakistani Other 
Black or Black 
British 
African Caribbean Other 
White British Irish Other 

Mixed White & 
Asian 
White & 
Black 
African 
White & 
Black 
Caribbean 
Other 
Other 
ethnic 
groups 
Chinese Gypsy 
Traveller 
Other 
Disability: 
Does your child have any current injuries? If yes please give a brief description. 
Does your child have any long-term injuries or health issues? If yes please state below. 
Does your child have any allergy and/or dietary requirements? All food vegetarian and Halal 
Which of the following best describes how you found out about us? 
Friends Word of 
Mouth 
Health 
Professional 
School 
Internet Social 
Media 
Community 
Venue 
Leisure 
Centre 
Other 
I give consent for my child to take part at their own risk, and understand that the activities involved 
may be hazardous by their nature and involve a risk of injury. 
Name: ________________________________ Signature: ______________________ 
Date: _______________ 

Photography, Filming and Recording Consent 
I give consent for Leeds City Council to publish, republish or otherwise transmit, still and moving images and 
audio of my child for the purposes of: 
. Publicity materials, including printed publications 
. Presentation and exhibition materials 
. Websites, intranet, social media channels and digital communications 
. News media and their associated websites and social media channels including 
. Print, television and radio 
Your signature 
I am responsible for the person identified on this form and in the photograph(s), filming and/or recording. I 
understand the above request and give informed consent. 
Signature: D a t e : 
Privacy Statement The data you provide on this form, and any photographs/moving images/audio taken at 
this event will be held in accordance with the GDPR and Data Protection Act 2018. Leeds City Council is the 
Data Controller of this information, and it is being processed only with your explicit consent. 
Permission relates to Leeds City Council official or endorsed promotional materials only, and your personal 
data will be held only for 24 months, unless revised consent is given. Please supply an email address and/or a 
telephone number so that we may contact you for further consent if we wish to continue using the images 
after this period. 
Details of your rights under UK Data Protection Legislation, including details of the Council’s Data Protection 
Officer, your rights as a Data Subject, and your right to complain to the Information Commissioner’s Office are 
available at the following website: 
https://www.leeds.gov.uk/privacy-statement/privacy-notice 

Privacy Notice Form 
The information you provide on this form will only be used to create case studies and 
report. Leeds City Council are the Data Controller responsible for your data and, 
excepting if required by law, your data will not be shared with any third parties apart 
from our partner organisations who are contracted to provide administrative support 
to us. 
I confirm that I have read and understood the Terms and Conditions and Privacy 
Statement for my application [ ] 
Leeds City Council would also like to use the contact details that you have provided 
on this form to offer you information on other Leeds City Council leisure related 
activities and events. 
Please tick here if you would like to take advantage of this offer [ ]. 
Please then state how you would prefer to be contacted Email [ ] Phone [ ] Post [ ] 
Full details of how Leeds City Council will process your personal information are 
contained within our Privacy Statement. 
Details of your rights under Data Protection Act 2018, including details of the 
Council’s Data Protection Officer, your rights as a Data Subject, and your right to 
complain to the Information Commissioner’s Office are available at the following link: 
https://www.leeds.gov.uk/privacy-statement/privacy-notice