Football Project
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Full name of young person
 *
Date f Birth
 *
MM
/
DD
/
YYYY

Does your child have any support needs or a registered disability?

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If ticked Yes, please provide more details that will help us to support them.
Does your child have any dietary requirements, allergies or medical information?
*
Next of Kin, Emergency Contact 1 
Name, contact telephone number and relationship to young person
 *
Next of Kin, Emergency Contact 2
Name, contact telephone number and relationship to young person
 *

Photo consent.
We take photos from time to time, which help to raise awareness of our work and to secure future funding for similar activities.

Photos would be used for promotional purposes, such as social media, our annual newsletter and website.

Our Privacy Policy can be found and read here: https://www.winchesterstreetreach.org/privacy-policy/

Please tick Yes to consent
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Safeguarding and consent Declaration:

·"Safeguarding is everyone's responsibility" and confidentiality and safeguarding underpin all of the work we do at Street Reach.

Our duty of care starts when we pick-up your child or when they arrive to our project at Unit 12. It ends when they leave the project or when we drop them off.

In checking the below consent box and typing your name, you are agreeing to your child taking part in the young persons interview panel on:

Thursday 4th May at Unit 12, Winnall Valley Road, Winchester.

You are also consenting toi them travelling with us to and from their home address (if this option is required)

In the event of an emergency where medical treatment becomes necessary, I agree for Street Reach staff to act as required, including signing a consent form on my behalf if needed by the medical authorities. 

Our safeguarding policy can be fund and read here:

https://www.winchesterstreetreach.org/wp-content/uploads/2017/04/WSR-Safeguarding-Policy-November-2021.pdf

Please tick Yes to consent:

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Consent to Transport
Transport is pick up from Unit-12 5:30pm
drop off is Unit-12 or Stanmore Shop Front (Wavell Way or Cromwell) 7:45/8:00pm
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Sign Full name of parent/carer
 *
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