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ICAN Children and Young People Registration and Consent Form
To reduce paperwork, we will issue one registration form each year to cover all activities delivered for children and young people by the Deafness Resource Centre. If there are any activities that require additional consent we will contact you.
**If any of your/ your child's information changes please let us know so we can update our records.
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Childs name *
Childs address *
Childs date of birth *
Does your child have any medical conditions/ disabilities we need to know about? *
Who are your child's emergency contacts? *
Parents name, address, contact number  *
Is your child any of the following *
Required
What is your child's communication preference/ first language *
Required
Does your child use any assistive technology? *
Required
What services offered by the Children & Family team would you like to know more about? *
Required
Do you give photograph/ video consent for your child?

At the DRC we would like to take photographs/videos of which could include yourself and/or your child(ren).

We may wish to include these photographs/videos in future promotional material such as leaflets, Facebook pages, websites etc.

Could you please indicate if we have permission to use yours and/or you child’s photographs/videos and where we may do so by completing the information below?

 *
Required

CUSTOMER PRIVACY NOTICE

Here at the Deafness Resource Centre we take your privacy seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us.

The DRC will never share your personal data with third parties without your consent. Your data will be stored and disposed of securely and only used for the purposes stated above.

If you agree to your personal data being processed as outlined above please sign below to confirm consent. You have a right to access your personal data at any time and consent to process the data can be withdrawn.

Failure to provide personal data may result in the DRC being unable to provide services or enter into an agreement with you.

From time to time we would like to contact you with details of other [products]/ [offers]/[services]/[competitions] we provide. If you consent to us contacting you for this purpose please tick to say how you would like us to contact you:

 *
Required
Does your child have any disabilities we need to know about? *
Does your child have any food allergies or intolerances we need to know about? *
Does the Deafness Resource Centre staff have consent to allow emergency medical treatment be given to your child in the event or an illness or injury? *
Required
Does the Deafness Resource Centre staff have consent to transfer your child to hospital in the event we cannot successfully contact you? *
Required
Privacy notice - Do you consent to yours/your child's information being processed and stored by the Deafness Resource Centre.
(If you wish to read our full privacy notice please email ICAN@deafnessresourcecentre.org)
 *
Required
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