Parent/Carer Consent Form
Circles Alt Ed www.circlesalted.co.uk 01277 280396
Parent/Carer Name
First Name
Middle Name
Last Name
Parent/Carer E-mail
example@example.com
Student Name
First Name
Middle Name
Last Name
Student Gender
Please Select
Male
Female
N/A
Student Date of Birth
Who can collect the student?
Please provide name, relationship with student and phone number
Can Circles staff administer sun cream?
Yes
No
Can the student leave Circles with a member of staff? E.g on a trip to a shop or supplier related to the course.
Option 1
Option 2
Option 3
Can the student leave Circles with a member of staff? E.g on a trip to a shop or supplier related to the course.
Yes
No
Has the student had a tetanus immunisation in the last 5 years?
YES
NO
UNSURE
Is the student known to use a vape or smoke?
YES, Smoke
NO
Yes, Vape
Clothing
Attendees must wear suitable and appropriate clothing for the course in which they are attending. As a large majority of the work they are likely to be doing involves practical work it is likely that some form of permanent marks will be made on the attendees clothing even when wearing the provided protective layers. Particularly if on a Circles Farm course attendee must wear suitable clothing for working outdoors in the current season on such activities that are likely to take place on a farm. If students arrive in unsuitable clothing they may be asked to leave. This could include clothing with offensive designs on, clothing that does not cover an appropriate amount of the body, etc. All students are required to wear tops that cover their shoulders and torso at all times.
Risk
All our activities are risk assessed and the student will be kept safe while at Circles. However, you should be advised that some activities are classed as ‘Risk Present’. There are also risks associated when working/handling animals. Suitable protection from the sun should be provided during hot weather, i.e. hats or caps and tops which cover the shoulders. We will not routinely apply sun cream and failure to provide suitable protection from the sun may result in the attendee missing activities.
Please list any medical needs, allergies or health support that is required:
Allergies, medication, hayfever etc
Banned Items
To minimise disruption to the working day a number of items are considered ‘Banned’ and should at no time be brought with the student to Circles. If a student is found with any of the following they will be confiscated and not returned to the student directly but either sent to the school or directly home; expensive electronic equipment, energy drinks, mobile phones, photographic equipment, cigarettes, matches, lighters, expensive jewellery, offensive weapons, illegal drugs and any other illegal or inappropriate material. Any student found in possession of a banned item will be reported to the, Parent/carer, School and Police and may result in their placement being suspended/cancelled.
Are you happy to be contacted by Circles in the future?
Yes
No
I understand that photos and videos will need to be taken of the student as part of the evidence gathering required for the qualifications. These images may be used on site displays, our website and so on.
I consent
Signature
APPROVE
Should be Empty: