Microsoft word - lcf global parental consent 2013_2014 (2).doc
LCF complies with the Data Protection Act 1998. All of the data given on this form will be held and used in accordance with this Act. SECTION 1 – this data will help us to contact you should we need to during our activities and trips. Contact Details for Young Person
We would like to keep you posted with news about activities and trips that LCF Youth runs throughout the year. If you’d prefer not to hear about this stuff then please tick the box [ ]
Contact Details for Parent/Guardian (where different from above)
We would like to keep you informed with news about LCF. However, if you prefer not to receive news from LCF, please tick this box [ ]
SECTION 2 – MEDICAL INFORMATION. This data will help us to give the best possible care to your young person during activities and trips
Name of family Doctor: Address and phone no. of family Doctor:
Please give details of any allergies affecting your young person and/or details of any medication your young person is currently taking, including the dosage and whether it can be self-administered:
Please give details of any contagious or infectious diseases your young person has suffered from in the past 3 months, or other recent illnesses:
Please give details of anything which may affect fitness to participate in certain activities, or which may affect their wellbeing (e.g. recent operations, phobias, sleepwalking, toileting difficulties, etc):
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Please give date of last anti-tetanus injection:
Please give details of any special dietary requirements your young person has:
If supervised swimming is offered on the programme, do you give consent to your young person taking part? YES / NO If consent is given, what distance can they swim?
Please give details of any types of activities and trips in which your young person may not participate:
Please give any other information you think may be useful to us in caring for your young person, e.g. suffers from travel sickness:
Do you consent to us providing your young person with paracetamol or Ibuprofen if necessary YES / NO
SECTION 3 – to be read and signed only by a parent or other adult with parental responsibility.
I give permission for my young person to take part in LCF Youth activities and trips and I understand the nature of the activities and trips that will be undertaken and the travel arrangements.
I understand that travel to LCF Youth activities and trips will be a combination of public transport, minibus and personal cars.
I understand that the leaders will take all reasonable care in looking after my young person but they cannot necessarily be held responsible for any loss or damage to property during, or as a result of LCF activities and trips
In an emergency, if I cannot be contacted, despite all reasonable attempts to do so by the leaders, I give permission for my young person to undergo emergency medical/dental treatment including the use of anaesthetics as considered necessary by the medical authorities.
I give permission for LCF to process the personal data given on this form for use in relation to my child taking part in these activities and trips.
I understand that by participating in LCF Youth activities and trips, video/photographs of my young person may be taken with other young people for future promotional purposes. Please tick this box if you do not consent to video/photographs of your young person to be used. [ ] I understand that by participating in LCF Youth activities and trips, video/photographs of my young person may be taken with other young people for use on the LCF/LCF Youth website. Please tick this box if you do not consent to video/photographs of your young person to be used. [ ] I understand that if my young person grossly misbehaves during activities and trips then the organisers may forbid them from further participation and require me to collect them at my expense. (Cigarettes and alcohol are forbidden and failure to abide by this rule may constitute gross misbehaviour.) I agree to pay for deliberate damage to property caused by my young person.
I undertake to inform LCF before each activity of any changes to these details.
Parent or other adult with parental responsibility Relationship
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