Bowles Consent Form- Under 18`s
Transcription
Bowles Consent Form- Under 18`s
Bowles Consent Form - Under 18’s Name of Child: Booking ref: (open courses/ private lessons only) Address: Date of Birth: Group/Course: Primary Contact Alternative contact Name Relationship Contact numbers Email address* *We may use this to inform you about activities and courses MEDICAL & DIETARY INFORMATION - Please complete both sides of this form Does your child have: Y/N Details/Notes/Medication Dietary requirements eg veggie/halal Dietary allergies/ Epipen carried? Hay fever or other allergy Asthma Diabetes Epilepsy/Fainting/Migraine ADHD/Autism/Aspergers/Dyspraxia Current tetanus injection Current medication Any other medical condition, further details or relevant information Photos: Bowles uses photos and video for publicity, educational purposes and to feed back to our funders. Please tick this box if you do not give us permission to photograph your child. Please tell your child if you have ticked this box. Our photo policy is based on NSPCC guidelines: www.bowles.ac/policies Declarations: I give my informed consent for my child to take part in an activity course at Bowles. Bowles is an Outdoor Education Centre offering a range of outdoor and adventurous activities which can never be entirely risk free. I give permission for any medical treatment deemed necessary to ensure my child’s wellbeing. I declare that the information I have provided is correct and I have not withheld anything. Parent/Guardian signature: Date: