Torfaen Youth Forum - Consent Form

Permission request for the following event:

Torfaen Youth Forum

WHERE: Torfaen Council, Civic Centre, Pontypool, NP4 6YB

WHEN: Last Wednesday or each month. 4pm-6pm

ORGANISED BY: Youth Provision (leading on the event): Torfaen Council's Communications & Engagement Team

Participant's name

* required

Maximum 255 characters

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Address

* required

Postcode

* required

Maximum 255 characters

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Participant's date of birth

* required

Participant's gender

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Participant's phone number

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E.mail for participant

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Does the participant have any medical conditions

* required

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Does the participant have any allergies (medical or otherwise)?

* required

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10.

Please supply doctor/GP's name, address and telephone number

* required

11.

What is the date of last tetanus injection

* required

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12.

Any dietary requirements (such as vegan, lactose intolerance, etc).

13.

Is there any other information you would like to make us aware of?

14.

Who should we call in the event of an emergency - please add the person's name and relationship to the participant

* required

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15.

Please add the phone number/mobile of the person listed as the emergency contact

* required

Maximum 255 characters

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16.

Alternative emergency contact should we not be able to reach the listed Next of Kin. Please add name, relationship to the participant, and a mobile number.

Please tick and read the statements below to complete your consent

17.

I acknowledge receipt of and understand the information regarding this proposed visit/activity and give my consent for the person named above to attend.

* required

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18.

I have ensured that my child understands the information for his/her safety and for the safety of the group and that any rules and instructions given by the staff are to be obeyed.

* required

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19.

I understand that any misbehaviour could result in my child being removed from the activity and returned home, with transport costs to be met by myself, the parent or guardian.

* required

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20.

I agree to inform the leader of any changes or alteration to the details provided prior to the date of departure.

* required

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21.

I give permission for staff who are in loco parentis of my child to seek and provide medical treatment in an emergency, including anaesthetic.

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22.

I give permission that any photographs or video taken during this activity can be used for publication (incl. but not limited to Torfaen Council's social media channels and press releases)

* required

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23.

I give permission for the information on this form to be kept in a database for reference in accordance with UKGDPR regulations

* required

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24.

Please type your name if completing this form on behalf of a participant under 18 years of age. This will mean you have signed this form.

Maximum 255 characters

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25.

Please state your relationship to the participant (carer, father, mother, guardian, etc) if completing this form on their behalf

Maximum 255 characters

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26.

Participant's name - this will act as your signature

* required

Maximum 255 characters

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27.

Please add today's date to this form

* required