T.A.S.C. Consent Form

T.A.S.C. Consent Form
Child's Name

First NameLast Name
INTERNET AND ELECTRONIC DEVICES POLICY CONSENT FORM

I consent to my child using the computers and Internet access provided by the service. The service will make all reasonable efforts to make sure that the internet is being used safely and responsibly, and that games played on the computer are age appropriate for my child.

My child and I accept the undernoted Code of Conduct. This conduct states that my child:

• Will always ask before I use the Internet.
• Will not give my, or anyone else’s, name, address or telephone number to anyone on the Internet.
• Will not post pictures or video of myself, or anyone else, on the internet.
• Will never agree to meet someone that I have spoken to on the Internet.
• Will not attempt to access inappropriate websites or content.
• Will not download programs or bring programs on disk, memory stick or CD Rom from home into the club.
• Will not use their phone/IPod/device in a way which disturbs others.
• Will not use their mobile phone to take photos in the club.
• Will not photograph or record any child in the service
• Will not photograph or record any staff member or visitor to the service

I consent to the use of electronic devices, and I have discussed the above responsibilities with my child and we accept the code of conduct.
Signature

Clear
PHOTOGRAPHY

We are seeking consent from both children and parents to give permission for photographs or videos to be displayed on our website, social media site and our wall display. I give permission for the above
Name

First NameLast Name
Signature

Clear
Additional comments (optional)
SUNSCREEN

Parents should apply sunscreen in the morning prior to accessing the service ,and children should carry their sunscreen with them. If your child needs to use the services sunscreen or/and needs help with applying it, then I agree to the following:

My child has no known allergies and I give my consent allowing my child to use the service sunscreen cream, or any available cream when they do not have their own. I am aware that the staff will supervise children putting the cream on, and where possible will ask my child to team up with a friend to help them apply it.
Please sign the appropriate statement
My child has no allergies, and if they do not have their own sunscreen, I consent to the above

Clear
My child has allergies and I will be providing sunscreen for their own use and I consent to the above.

Clear
Click 'Submit' or click 'Next' to go to our Prescribed Medication Consent Form

T.A.S.C. PRESCRIBED MEDICATION CONSENT FORM
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Emergency Contact Name and Number (1)
Emergency Contact Name and Number (2)
Named of Medical Condition
What medication is stored at the service to treat this condition
Can this condition lead to a medical emergency or be classed as life threatening

YesNoUnknown
Date of first dose of medication
Date and dose of the medication last administered by the parent
Dosage
Frequency
Date due to complete the course of medication
Is there any further medication or in the child's bag for example that treats this condition? Please list any other medication that your child is currently using, and state if this has been prescribed or purchased over the counter (OTC)
What symptoms or signs should staff be looking out for and aware of? What should staff do if the child presents these symptoms? Please detail instructions that staff should follow, such as administering medication, calling 999, etc.
Does your child have any allergies?

YESNO
Please state
Please list any special instructions.
I CONFIRM THAT

• This is not the first dose of this medication that my child has had.

• I authorised the staff at T.A.S.C. to support my child to administer this medication

• I have been issued or accessed a copy of the administration of medication policy

• I understand that all medication will be stored appropriately and administration will be logged
Parent’s Signature

Clear
Date

MonthDayYear
Date
Designated Staff member
Date

MonthDayYear
Date
THE MEDICATION WAS RETURNED TO PARENT/CARER ON
Parent's Signature

Clear
Date

MonthDayYear
Date
Staff Signature

Clear
Date

MonthDayYear
Date
Click 'Submit' or click 'Next' to go to our Over the Counter Medication Consent Form

OVER THE COUNTER MEDICATION CONSENT FORM
Child's Name

First NameLast Name
Date

MonthDayYear
Date
Medication
Reason for Medication
Date of first dose of medication
Date and dose of the medication last administered by the parent
Date due to complete the course of medication
Dosage
Frequency
Please list any other medication that your child is currently using, and state if these have been prescribed or purchased over the counter (OTC)
Does your child have any allergies?

YESNO
Please state
Please list any special instructions
I CONFIRM THAT

• This is not the first dose of this medication that my child has had.

• I authorised the staff at T.A.S.C. to support my child to administer this medication

• I have been issued or accessed a copy of the administration of medication policy

• I understand that all medication will be stored appropriately and administration will be logged
Parent's Signature

Clear
Date

MonthDayYear
Date
Designated staff member
Date

MonthDayYear
Date
THE MEDICATION WAS RETURNED TO PARENT/CARER ON
Parent's Signature

Clear
Date

MonthDayYear
Date
Staff Signature

Clear
Date

MonthDayYear
Date
If your child has medical healthcare needs then please click 'Next' and fill out our T.A.S.C. Health Care Plan for a child with Medical Needs form. If this doesn't appy to your child then click 'Submit' to our consent form below.

T.A.S.C. Health Care Plan for a child with Medical Needs
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Date of Birth
Keyworker
Medical Condition
Medication Required
Staff trained to administer medication
Date plan drawn up
Review date

CONTACT INFORMATION
Family 1 Contact & Relationship
Name

First NameLast Name
Phone number
Work telephone number
Home telephone number
Mobile number
Family 1 Contact & Relationship
Name

First NameLast Name
Phone number
Work telephone number
Home telephone number
Mobile number
GP Name
Practice
Telephone number
Clinic / Hospital Contact
Name

First NameLast Name
Phone number
Medical condition and details of child’s individual symptoms
Action to be taken if blanks Occurs
Step 1
Step 2
Step 3
Medical condition and details of child’s individual symptoms
Action to be taken if blanks Occurs
Step 1
Step 2
Step 3
What constitutes an emergency for the child
Who is responsible in an emergency
First Aider/ (person in charge)
Parent / Carer

Clear
Date

MonthDayYear
Date
Head of Centre

Clear
Date

MonthDayYear
Date

CONTACTING THE EMERGENCY SERVICES
Dial 999, ask for ambulance and be ready with the following information

Your telephone number

Give your location as follows (insert school/setting address)

Antonine Primary, 4 Abbotshall Ave, Drumchapel, Glasgow G15 8PR
0141 944 6868 / 07824 427916

Knightswood Primary 36 Knightscliffe Ave, Glasgow G13 2TE
0141 950 2779 / 07585 918074

St Clare's Primary 15 KIlcloy Ave, Drumchapel, Glasgow G15 8RP
0141 944 1758 / 07824 390076

St Ninians Primary, 2150 Gt Western Rd, Glasgow G13 2AB
0141 950 2497 / 079013 85999
Entering from Gt Western Rd if in the playground and Blairdardie Rd if in the unit.

Give your name

Give name of child and a brief description of the child’s symptoms

Inform Ambulance Control of the best entrance and state that the crew will be met and taken to………
Should be Empty:

T.A.S.C. Consent Form

T.A.S.C. PRESCRIBED MEDICATION CONSENT FORM

OVER THE COUNTER MEDICATION CONSENT FORM

T.A.S.C. Health Care Plan for a child with Medical Needs

CONTACT INFORMATION

CONTACTING THE EMERGENCY SERVICES