Thank you for your interest in the Dance vs Diabetes Summer School! Please complete this registration form.

Details of Person Wishing to Attend the Summer School
Name
Age
Address
Email
Do you have any health problems we need to know about, including regular medicines you need to take or allergies?
Do you have any disabilities we need to know about?
Do you have any dietary requirements?
Details of Parent/Guardian if under 16
Name of Parent/Guardian
Phone number in case of emergency
Address
Email address
Please sign to confirm
that you will be attending with the young person
Are you happy for your child to be included in video and photos of the event? These will be used on our social media accounts, website and future publications. / □ Yes
□ No
What sessions do you want to attend (Monday-Friday)? Please tick.
Session / Mon 14th August / Tues 15th August / Wed 16th August / Thur 17th August / Fri 18th August
Talking Health
(11-16 year olds)
11am-12am
Little Bollywood Stars
(6-11 year olds)
11am-12am
Healthy Living
(6-11 year olds)
1-2pm
Bollywood Dance
(11-16 year olds)
1-2pm
The Maths of Health
(11-16 year olds)
2pm-3pm
Dancing with Diabetes
(16+ year olds)
6pm-7.30pm
What sessions do you wish to attend on Saturday 19th August? Please tick.
The Maths of Health and Talking Health
(11-16 year olds)
10am-11am
The Maths of Health and Talking Health: Poster Exhibition
Any age, exhibitors 11-16 year olds
11am-12am
Dancing Together
Whole families, any age
1pm-2pm
Dancing with Diabetes
(16+ year olds)
2pm-3pm
Dancing with Diabetes
(16+ year olds)
3pm-4pm

Data Protection

The information we have asked for above is only used to help us run the Summer School safely and efficiently. It won’t be used for anything else.

Clinical Measurements

In some of the sessions, as detailed in the programme, we are taking measurements of health from people taking part and from willing parents too! This will include:

  1. Height, weight and body mass index (BMI)
  2. Body composition using Tanita scales: you step on a set of special scales which pass a very small electric current through you. You won’t be able to feel it at all. It tells us how much of your body is made up of water, fat, muscle and other things like bones and eye balls.
  3. Accelerometry: this is the name for measuring movement. There are several devices we will try out, including one that is like a watch and one that measures your heart rate with a strap round your chest which is worn underneath your clothes. You or your parent will fit the devices, and you can put them on in private.

You will have your own measurements, but they won’t be used for your healthcare. We’re just using them for the Summer School. A Doctor won’t look at the results for you and we won’t be using them to decide if there is anything wrong with you. If you want, you can share your measurements with your GP yourself but we won’t be doing that for you.

We will be using the measurements to think about levels of activity and how that relates to what we eat. Other people in the group will see your measurements, but they won’t know whose measurements are whose.

If you don’t want to use your own measurements for any reason, you can use measurements from the staff and still take part in the sessions.

Exercise

We’re doing exercise, so it’s important you also fill in the PAR-Q form to check it’s safe for you to do exercise.

Please return the registration form along with a completed PAR-Q form to Rebecca Pritchard, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW.

Dance vs Diabetes Registration Form V1.0 10/07/2017