3-11's Consent Form
Please complete this form for each child attending !Audacious Conference
Delegate Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Home address
Your answer
Postcode
Your answer
Parent/Guardian's Full Name (to be contacted in an emergency)
Your answer
Relationship to Child
Your answer
Parent/Guardian's Contact Number
Your answer
Parent/Guardian's Email
Your answer
MEDICAL DETAILS: Please give any details, including name and dosage of any medication your child takes/or will need to bring to !Audacious Conference. This includes Asthma inhalers.
Your answer
Person to contact in an Emergency
Your answer
Emergency contact number
Your answer
Name of Family Doctor
Your answer
Contact Number
Your answer
Doctor's Address
Your answer
Medical History - please tick any that apply
Please specify other illness or disability and/or dietary requirements
Your answer
Other - Please use this space below to tell us of anything else the !Audacious Kids team may need to know about your child. We endeavour to make !Audacious Kids a memorable experience for every child, so if your child has any special requirements PLEASE inform us.
Your answer
I understand that !Audacious Kids Team will take all reasonable steps to provide a safe environment for my child and to ensure all equipment supplied by them for activities is of a standard fit for the purpose. I consent to photographs/video to be taken of my child during conference week and for them to be used solely for the use of Live !Audacious Conference and during the week. I consent that my child may take part in face painting activities. I consent that my child may eat sweets, ice lollies, ice creams or additional snacks given by the !Audacious Kids team. I agree that !Audacious Kids Team may authorise on my child’s behalf any basic medical treatment or first aid he/she may reasonably require. I agree to provide my child with a packed lunch and will send it with them in a labelled bag.
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