This form must be completed and signed by a Parent or Guardian

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This form must be completed and signed by a Parent or Guardian Powered By Docstoc
					                This form must be completed and signed by a Parent or Guardian (please tick appropriate boxes).

                                                                          Participant Details
                        Participants                                                              Date of Birth:
                        Name:
                        Course Title:
Parental Consent Form
                        Activity:                                                      School:
                        Dates:                                                         Year:
                                                                          Parental Consent
                        I am aware of the nature of the programme that my child is about to participate in. I understand that while the
                        school staff in charge of the party will take all reasonable care of the children they cannot necessarily be held
                        responsible for any loss damage or injury suffered by my son/daughter arising from or during the Centre’s activity. I
                        understand that I can seek more detailed information by contacting The Stables Outdoor Learning Centre by
                        phone on 0121 445 3177, or by e-mail at stables@boec.bham.org.uk or by visiting The Outdoor Learning Service
                        website at www.outdoorlearningbham.org.uk

                                 I consent to my child taking part in all activities organised by the staff in connection with
                                 the programme.

                                 I have told my child to pay particular attention to Staff giving advice on matters of
                                 safety, behaviour and general procedures.


                        Parent/Guardian                         ……………………………..                                     Date: ……………..
                        Signature:
                                                                Photographic / video consent
                        I give my permission for photographs to be taken and used for publicity purposes including leaflets,
                        posters and on the website. These will only be used by The Outdoor Learning Service and/or the
                        Royal Yachting Association Onboard. Please tick box if you DO NOT give permission
                                                               Medical Information
                                 Please provide any information regarding medical conditions that may be relevant
                                                               (This information will be treated in confidence)


                        Does your child suffer from Asthma, Allergies, Diabetes, Epilepsy, Other?                               None
                        Please provide details


                        Is your child currently taking any medication? e.g. antibiotics, inhaler                                None
                        Please provide details


                        Is there anything else that you could bring to our attention? e.g. travel sickness                      None
                        Please provide details


                        Has your son/daughter had a tetanus injection in the last 10 years                          No            Yes

                        I agree to my child receiving emergency medical treatment, including
                        anaesthetic, as considered necessary by the Medical Authorities present                      No           Yes

                                                           Water Confidence (for water sports only)

                        My child cannot swim                       Is just water confident                          Can swim 50 metres

                                                                Emergency Contact Information
                        Home Address:
                                                                                                  Parent/Guardian
                                                                                                  Home Tel:
                                                                                                  Mobile:
                        Post Code:                                                                Work:

                        Second Emergency Contact Person                  Name:
                                                                         Phone Number:
                                                      The Stables Outdoor Learning Centre (BOEC)
                                            Spirehouse Lane, Blackwell, Bromsgrove, Worcestershire. B60 1QE
                                                         Tel: 0121 445 3177 Fax: 0121 445 0532
                                                           Email: stables@boec.bham.org.uk

				
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posted:10/2/2012
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