Parental And Medical Consent Form For A Trip (Page 2 of 2) in pdf

Parental And Medical Consent Form For A Trip Page 2

Details of any medication to be taken, include frequency and any relevant side effects?

Do you have any disabilities? YES / NO

If yes, give details

Do you have any other special needs?

(dietary, wheel chair access)

TRAVEL

I am happy for my child to be transported by a member of Radnor YFC of either sex to and

from club visits and events if this was necessary.

YES/NO

IF YOU ARE UNDER 18 YEARS OF AGE PLEASE GET A PARENT/GUARDIAN TO SIGN THE

FOLLOWING DECLARATION:

I have read and understood the attached itinery and hereby give my consent for

…………………………………………………..to take part in this/these events. I understand that the

insurance policy is made available to me via the County Office or NFYFC website and understand

the extent and limitations of the insurance cover provided.

I understand that while the adults in

charge of the party will take all reasonable care or the young people, they cannot necessarily be held

responsible for any loss, damage or injury suffered arising during or as a result of the activity.

Signature of Parent/Guardian:

Date:

The above medical information is correct as far as I know. In the event that I cannot be reached in

an emergency, I hereby give my permission to the physician, selected by the chairman/club leader

acting on behalf of the club to hospitalise or treat my son/daughter, including proper anaesthesia,

injection, or surgery.

Signature of parent/guardian:

Date

Under the Data Protection Act 1998 we need to obtain your consent before photographing your

son/daughter. We therefore ask your consent for still photographs to be taken of your son/daughter

either by Radnor YFC for use within displays, the website or for marketing and advertising purposes,

in addition local press may also photograph participants on occasions.

I also consent for

photographs to be used in publicity and marketing at NFYFC.

Signature of parent/guardian:

Date

Parental And Medical Consent Form For A Trip Page 2