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Watermans Parent Consent Form
Programme *
Select programme for the parental consent agreement. If your programme is not listed please contact the Watermans Customer Relationship Team on 020 8323 1010 or email info@watermans.org.uk.
About the Young Person
First Name *
Please enter first name only
Your answer
Given Name *
A given name is what you call yourself, how you prefer to be known. So John may prefer to be known as Jack, Mei-You as Mei, etc.
Your answer
Family Name *
Your answer
Home Address of the Young Person
Home Address: Apartment and Street Address *
Your answer
Home Address : Town *
Your answer
Home Address : Post Code *
Your answer
Date of Birth *
Please enter the date of birth of the young person, including year
MM
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DD
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YYYY
Gender *
School
Which school/youth club does the young person attend
Your answer
School Year
Which school year are they in?
Your answer
Ethnic Origin *
Parent or Guardian
Name *
Your answer
Mobile Telephone Number
Your answer
Home/Work Telephone Number *
Your answer
Email Address
Your answer
Other Emergency Contact
Name
Your answer
Mobile Telephone Number
Your answer
Home/Work Telephone Number
Your answer
Email Address
Your answer
Relationship to Young Person
Additional Needs
Support *
Please describe any additional needs, support or disabilities we need to know about. If none, please enter “None”.
Your answer
Medical *
Please describe any medical conditions we should be aware of, including allergies, asthma, diabetes and epilepsy (including any current medication). Please note that medication cannot be administered by Watermans staff. Assistance with taking medication prescribed to the young person will only be given after receipt of a signed Medication Assistance Agreement between Watermans and parent/guardian. If none please enter "None".
Your answer
Declaration
I give permission for the Young Person to take part in the workshops and activities as booked at Watermans Arts Centre.

I agree that Watermans may act on my behalf in all urgent matters affecting or concerning the Young Person. I understand that all reasonable efforts will be made to contact me before taking action, but in particular cases this may not be possible. Upon contact I, the parent/guardian, will make every effort to respond to the Watermans request.

I agree information may be shared with workshop leaders, workshop assistants and relevant staff to support the young person’s participation in the workshop.

Photo consent *
Watermans occasionally makes photographs, film or sound recordings of and by participants which may be used in a variety of media for the purpose of promoting Watermans activities or celebrating the work done. Individuals will not be tagged or otherwise specifically identified without separate consent
Independent Travel *
Watermans understands that parents/guardians of older children may wish for their child/young person to travel independently. If this is the case permission must be granted by the parent or guardian. Best practices in safeguarding children and NSPCC guidance suggest that Children under the age of 12 should be accompanied to the workshop/class.
Authorised person(s) to pickup young person
I understand that there can be up to three authorised people to drop off/pick up the young
person and that Watermans must be informed in advance if the young person is to be collected by any person other than those named below. Best practices in safeguarding children and NSPCC guidance recommends that appointed people should be aged 16 or over.

Please ensure the workshop tutor/assistant knows who is picking up each session.

Authorised Person 1
Please enter the name AND relationship to the young person (Parent, Relative, Carer, Other)
Your answer
Authorised Person 2
Please enter the name AND relationship to the young person (Parent, Relative, Carer, Other)
Your answer
Authorised Person 3
Please enter the name AND relationship to the young person (Parent, Relative, Carer, Other)
Your answer
Acknowledgement
I hereby acknowledge the above declarations and confirm that I am the parent or guardian whose contact details appear above, that all information provided is correct and that should any details change I will contact Watermans to update this form
Full Name of Parent or Guardian *
Your answer
Date *
MM
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DD
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YYYY
Data Protection
All information is treated in the strictest confidence. Where appropriate information will be shared with the Workshop Leader and assistants to support the young persons safe participation in the workshop.
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