Parental consent form

Insight Community Project CIC Parental Consent Form

Once you have completed a form your child can attend our youth clubs and other activities. The youth club does not need to be booked, however, please check whether other activities do as some sessions may have limited spaces available.
Participant Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
School year*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Parent/Guardian Information
Name*

First NameLast Name
Relationship*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Emergency Contact Number*
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe. If you would like to speak to a member of staff in person about this. please feel free to do so.
I give consent for my child to receive necessary first aid or emergency medical treatment by appropriately trained persons. (We will always attempt to contact parents first, however, if we cannot get hold of you, we will follow guidance from the medical professional involved.)*

I consent
From time-to-time Insight Community Project will take photos and videos of activities and sessions. These will be used solely for the purpose for which they are intended, which is promotion or celebration of the projects and reporting to our funding providers. These may be used in printed or digital form and appear on our social media platforms. If you do not consent to this please inform the team via email at insightcic@outlook.com so that we can make a clear record of this.

I consent for my child to be in these photos or videos.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

Insight Community Project CIC Parental Consent Form