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Parental Consent Form
Parental Consent Form
Parental Consent Form
The Well
2022-01-17T12:06:15+00:00
Step
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This form is to give consent for your child / young person to engage in services provided by The Well.
Child/Young person's details
Name
First
Last
Home Address
Street Address
Address Line 2
City
County
Postcode
Phone
Email
Date of birth
Day
Month
Year
Parent or carer’s details
Name
First
Last
Address
Street Address
Address Line 2
City
County
Postcode
Phone
Email
Date of birth
Day
Month
Year
Child's medical details
GP
GP's Address
Street Address
Address Line 2
City
County
Postcode
GP's phone number
Any extra help we need to provide (for example because of a disability)
Do we need to know about any medical conditions or allergies? (If yes, please provide details for the condition(s) and any medication needed)
Is there anything else you think we should know?
Information for parents and carers
The Well aims to provide a safe and enjoyable experience for every child or young person. To help us do this, please note the following important information. • All questions on the consent form must be completed and signed by the parent or carer before any child takes part. [You should always gain parental consent for children aged under 16. For young people aged 16 and 17, you should decide whether parental consent is necessary depending on the activity and the young person’s circumstances. If you decide parental consent isn’t necessary, you should still consider whether parents or carers need to be informed that their child is taking part. In most circumstances, parents have a legal parental responsibility for their children up to the age of 18.] • Parents and carers must ensure they notify us of any changes to the information given on the form. • Parents and carers must make arrangements for children to be brought to and from the activity safely and on time. If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so. • We cannot take responsibility for any damaged clothing and/or personal items during the activity. • Parents and carers should ensure children have sufficient water, food, clothing, sun lotion and medication (where appropriate) for the duration of the activity.
I agree to (please tick):
my child taking part in the stated activity
I agree to (please tick):
The Well keeping a record of this form for health and safety reasons
I agree to (please tick):
any medical treatment that my child may need being given in an emergency
I agree to (please tick):
my child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity.
Note: if consent is not given, [name of group/organisation] will not use any
images taken during the activity that contain the child/young person.
Signature
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