11-18's Consent Form
Please complete this form for each young person attending !Audacious Conference
Date of Birth
Parent/Guardian Full Name (to be contacted in an emergency)
Relationship to Child
Parent/Guardian's contact number
Name of Family Doctor
Medical History - Please tick any that apply
Asthma or Bronchitis
Sight or Hearing Impairment
Fits, Fainting or Blackouts
Allergies to medications
Allergies to food, pollen or dust
Other illness or disability
Please specify other illness or disability and/or dietary requirements
I agree to the delegate named above taking part in the activities provided by !Audacious. I confirm to the best of my knowledge that the delegate named does not suffer from any medical condition other than those listed above. I consent that in the case of an emergency / or I am not contactable, I am willing for the delegate named above to receive the necessary medical treatment including anaesthetic. I understand that !Audacious accepts no responsibility for loss, damage or injury caused by or during attendance of !Audacious. I consent to any photo’s or media footage being taken of the delegate named above whilst taking part in !Audacious and understand that these may be used for future publicity. I consent to the delegate named above travelling by any form of public transport, minibus or motor vehicle driven by an !Audacious staff member during !Audacious. I agree for the Group Leader to sign a waiver form for the delegate named above to take part in activities at another venue.
By ticking this box you are agreeing to the terms and conditions presented.
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Terms of Service