Consent form – Bridgnorth Youth and Schools Project

Young Person's Details

This form is to be filled in by any parent or carer who wishes their child to attend activities managed by Bridgnorth Youth & Schools Project & The Bridge Youth Centre. The Bridgnorth Youth & Schools Project runs both the activities of The Bridge Youth Centre and its own activities. The data provided on this form will be held by both the Bridgnorth Youth & Schools Project and The Bridge Youth Centre. It will not normally be disclosed to any other third party and it will only be used to assist in managing activities effectively, safely, and to fulfil safeguarding responsibilities.

Young Person's Name *

First

Last

Date of Birth *

Young Person's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Parent/Carer Section

Parent/Carer Name

First

Last

Parent/ Carer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

ADDRESS OF PARENT / GUARDIAN DURING THE RESIDENTIAL IF DIFFERENT FROM THE CHILD’S ADDRESS ABOVE:

Parent/ Carer Phone

Please provide the most accessible phone number

Parent/ Carer Email

Confirm Email

Medical Information

Doctor's Surgery

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please fill in as much as you know about the surgery you attend.

Known Conditions

Please give details of any disabilities or medical conditions of which we should be aware

Dietary needs

Please give details of any special dietary requirements

Consent

Consent (Please tick to confirm)

I give permission for my son/daughter to take part in BYSP groups, trip or event related to this form entry.
I understand that the leaders and those organising these activities will take all reasonable care in looking after my son/daughter but they cannot necessarily be held responsible for any loss or damage to property during, or as a result of, the session, event or trip.
In an emergency, if I cannot be contacted despite all reasonable attempts to do so by the leaders and organisers of the activity, I give permission for my son/daughter to undergo emergency medical/dental treatment, including the use of anaesthetics, as considered necessary by the medical authorities.
I understand that if my son/daughter grossly misbehaves that the management may forbid them from further participation. I agree to pay for deliberate damage to property caused by my son/daughter.
I give permission for Youth Centre & Bridgnorth Youth & Schools Project to process the personal data given on this form for use in relation to my child taking part in activities. All information is kept in line with current data protection legislation. To view our privacy policies please visit: www.bridgnorthyouthandschoolsproject.co.uk
I understand that videos and photographs of young people attending activities may be taken by participants and staff and attendance at the activity signifies agreement that these may appear in future publicity or other materials produced for Bridgnorth Youth & Schools Project. (*Personal information is never disclosed when such materials are used, unless permission is obtained.)

If you’re concerned about any of these, please come to speak to us.

Parent/Carer Signature (Type your full name) *

THIS SECTION MUST BE SIGNED BY THE PARENT OR OTHER ADULT WITH PARENTAL RESPONSIBILITY.

Over 13's Signature (Type your full name)

THIS SECTION MUST BE SIGNED BY THE ATTENDING YOUNG PERSON IF THEY’RE OVER 13 YEARS OLD.