Brannel school samba band

CORNWALL STARS CHEERLEADING & TRAMPOLINING CLUB
Child Consent Form


Participant’s name: ………………………………………… Date of Birth …………………………
MEDICAL INFORMATION ABOUT YOUR CHILD

Does your child suffer from a medical condition/allergies? Yes 
If yes please give brief details (e.g. Asthma – takes ventolin, Diabetes – takes insulin) …………………………………………………………………………………………………………… …………………………………………………………………………………………………………. Is your child receiving any medical treatment at present? Yes  If yes, give details of illness/disability and treatment …………………………………………………………………………………………………………. Name and Address of own Doctor ………………………………………………………………… ………………………………………………………………………………………………………….
Doctor’s Telephone Number ………………………………………
Does your child have any special dietary needs? ……………………………………………….
Additional information from Parent/Carer if required …………………………………………….
………………………………………………………………………………………………………….
PARENTAL CONSENT
1. I have read the information provided and agree to my son/daughter taking part in the 2. I acknowledge the need for him/her to behave responsibly at all times. 3. I understand that the staff responsible for the activities will take all reasonable care of 4. I consent to my child travelling in a motor vehicle driven by a member of staff or other adult in the event of an emergency and in accordance with associated guidance. 5. Please note that if your child has an accident or suffers loss or damage to his/her personal effects or money which is not as a result of lack of care on the part of the club, the club will not be able to pay any damages or meet any expenses arising.
DECLARATION

I consent to any emergency medical treatment required by my child during this event. I will
inform the club of any changes of circumstances.
Parent/Carer Signature: …………………………………………………………………………………. Print Name ……………………………………………………… Address ……………………………………………………………………………………………………. Home Telephone No ……………………………………………………………………………………. Emergency Telephone No (if different) ………………………………………………………………… The Use of Images of Children
Parent/Carer Consent Form
Name of Child: ……………………………………. Please delete
as appropriate

1. I agree that the Cornwall Stars can take photographs of my child
Yes/No
which may be used in literature (e.g. newsletters and other promotional
material etc.)
2. I agree that the Cornwall Stars can use images of my child on its web Yes /No
site. (Please note the web site can be viewed across the world).
3. I agree that the Cornwall Stars can take photographs of my child for
Yes/No
the club’s own records, archives and future interest (e.g. photographs of session). 4. I agree that my child can appear in collections of photographs Yes/No
stored on CD ROMs which the Cornwall Stars may make of events and which it may sell to parents of children who have attended the sessions to raise funds for the benefit of the club. 5. I am happy for the press to take and use images of my child. Yes/No

6. The Cornwall Stars may give the press the first name only / first and Yes/No
surname (delete as appropriate) of my child for publishing
with the child’s photograph in a newspaper or for captioning on
television.
I have read and understood the conditions of consent. Signature of parent/carer: ……………………………………………………………. Date: ………………………… Name (in block capitals): ……………………………………………………………………

Source: http://www.cornwallcheerleading.co.uk/docs/Cornwall%20Stars%20Consent%20Form.pdf