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: