Request edit access
Aspire in Arts Medical Consent Form 
Please complete all the sections of this form. If you are under the age of 18 this form must be completed by a parent or guardian.
Sign in to Google to save your progress. Learn more
Name of Young Person *
Date of Birth *
Young Person Mobile Number 

 *
Full Address 

 *
Emergency Contact One- Name 

 *
Emergency Contact Number

 *
Emergency Contact Two- Name 

 *
Emergency Contact Number

 *
Are there any medical conditions/allergies? 
Name and Address of Doctor 

 *
Emergency Permission (To be filled out by parent/guardian if under 18). 

In the event of any illness or accident which requires medical treatment during activities or outings, I hereby AUTHORISE any member of the staff or event organisers to sign on my behalf any form or consent required by medical authorities. 

 *
By clicking agree above - I understand that I relieve all Aspire in Arts Ltd and all medical personnel concerned of all responsibilities for any complications and other consequences which the delay in treatment may cause. 

Please write your name and the date in the box below. 
 *
GDPR: Consent for the Use of Photography for Publicity Purposes (To be filled out by parent/guardian if under 18) From time to time Aspire in Arts Ltd require photographs and footage of young people to use in publicity material. I hereby ALLOW Aspire in Arts Ltd the right to use the photograph(s) and filming, for any reproductions or adaptations of the photograph(s) and filming for all general purposes in relation to the work of the project, including without limitation, the right to use them in any publicity materials, books, newspapers and website articles, including social networking sites whenever Aspire in Arts CIC chooses to do so. *
Please write your name and date as a digital signature for the completion of this form.  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Aspire in Arts CIC.

Does this form look suspicious? Report

Google Forms