Longridge water activities Permission Form

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By completing this form you are confirming you are giving permission for your young person to attend our Longridge water activity trip 14th August 2024.

All the necessary equipment is provided, including buoyancy aids. Wet suits are not required for any of our activities, although wet shoes are advisable for all water activities. If you don’t have wet shoes, a pair of old trainers is also fine! You just need something closed toe that will stay on your feet if submerged – so no crocs or flip flops, please. And if you’re going to get wet, make sure you bring spare shoes as well as clothes.

Email *

Details of Young Person

Name of Young Person *

Date of birth *

YYYY

Details of Parent or Guardian

Parent/Guardian Full name *

Relationship to Young Person (eg. parent) *

By checking this box I agree to the named young person attending Longridge activity Centre 2024. *

I Agree

Required

Emergency contact details

In an emergency on the 29th of May, I may be contacted on the following:

Telephone (Mobile) *

Secondary Contact

If I am not available on the above, please contact:

Full name *

Telephone *

Relationship to young person

Medical Information about Young Person

Any conditions requiring medical treatment, including medication?

Please outline any special dietary requirements or allergies?

Any medication allergies?

Do they suffer from any mental health or additional behavioural needs?

Medical Declaration

By checking this box I agree to the named young person receiving medication as instructed and any urgent dental, medical, surgical treatment, including anaesthetic or blood transfusion as considered necessary by the medical authorities present. *

I agree

Required

Data protection

All information provided on this form is held in the strictest confidence and is destroyed after two years. Information provided to Risborough Youth Club is not shared with any other third parties with the exception of relevant public authorities for the purpose of child protection and safeguarding.

Photographs and videoing

We would like to obtain your consent for photographing/videoing your ward/son/daughter. These photos and videos will be used to promote the work we do with young people, for example display boards at the club.

Consent

I do consent to photographs or videos to be taken

I do not consent to photographs or videos to be taken

Clear selection

Additional information

Is there any other information that would be helpful for us to know?

If any changes to the information you have supplied change, please notify Risborough Youth Club immediately.

Send me a copy of my responses.

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