TD1 Consent Form
In the event of an emergency, it is important that we have the necessary information about contact details and any medical condition that could affect the participation or treatment of the young person.  It is important that full and accurate information be given and that you notify us of any change in circumstances that might affect participation.

TD1 Youth Hub collects the information below to run activities safely and keep in touch. We only ask what’s necessary. Your details are stored securely and kept only as long as needed. You have the right to see, correct or delete your information at any time. Full details : Data Protection

Please visit the below link to read our Child Protection & Safeguarding Policy, should you have any concerns please take note of the contact details below.
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We use this information to contact you, confirm eligibility for activities, and keep you safe while attending
Name of Participant *
Date of Birth *
MM
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DD
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YYYY
Gender
Home Address *
Phone number *
Email address
Alternative Telephone number for use in emergency.  We use this only if we cannot reach the parent/carer. *
Has the above named person had recent surgery or been in contact with any infectious or contagious diseases? Please give description. *
Has the named above any known allergies? (eg Medication or Food)
Is the above named person currently undergoing treatment by a Doctor please give details including medication?
Has the above named person any medical condition which a doctor should know about before carrying out treatment(eg Asthma)  This helps us keep young people safe and provide appropriate support. Only staff who need this information will see it.
Is there any activity in which the above named person may NOT participate? (eg swimming)
Is there any additional information we should have or know?  (ADHD, travel sickness, diet, diabetes, etc?)
Has the above named person received a tetanus injection within the last ten years?
I give my consent for my child to take part in the activities available through TD1 Youth Hub, which includes minibus/public transport, outings, visits and outdoor and indoor activities. *
Required
I consent to TD1 Youth Hub using photos/videos of me/my child for publicity (e.g. social media, reports, funding). I understand I can withdraw this consent at any time by contacting admin@td1.org.uk *
Required
I give permission for TD1 to contact my child/me through phone, email, text or social media
Please tell us how you’d like us to contact you about TD1 activities and opportunities. You can change this anytime  
Insurance Information
TD1 Youth Hub has public liability insurance that covers claims arising from accidental injury or property damage caused by our negligence. We do not provide personal accident or third-party liability insurance for participants. If you wish to have this cover, please arrange it independently. Participants may be held responsible for any damage or injury caused through breaching agreed rules.  
Parent/Guardian Declaration (For under 16s)
I have read the information issued concerning the activity and the statement of insurance.  I understand the nature of the activity/activities to be undertaken and consider my child fit to take part.  They do not suffer from any medical condition not stated above.  I hereby consent to the submission of the above named to emergency medical or surgical treatment including the administration of treatment considered necessary by the medical authorities present.  I confirm the details are correct. I understand TD1 Youth Hub will use this information only for the purposes described. I can request access, correction, or deletion of my data at any time by contacting admin@td1.org.uk . I understand that should my child misbehave or act in a manner that causes damage or destruction that I am liable for these costs.

I have read and understood the above declaration.  *
Parent/Guardian full Name *
Date of completion and signature *
MM
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DD
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YYYY
Any further questions
If you have any further questions in regards to our organisation or the activities please contact us via:

TD1 Youth Hub Telephone Number = 01896 752 442 / 07970 554 260
Chief Executive, Douglas Ormston = douglas@td1.org.uk
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