Hampshire Federation of Young Farmers Clubs
www.hampshireyfc.org
Brockenhurst YFC Junior Christmas Party Parental Consent Form for all under 18's attendees 2nd December 2023 7pm - 10pm Brockenhurst Young Farmers Hall, Wootton Road, TipToe, Hampshire,SO41 6FT
Parental Permission to attend the above named event. 'Strictly no alcohol or outside drinks to be brought to the venue, all soft drinks, water and refreshments will be provided' HFYFC has a zero tolerance to alcohol and under 18's in accordance with the Code of Conduct & Behaviour Policy' It is important that all members are safe and enjoy YFC events.This form is to be completed and submitted by the parent/guardian of the member or guest.
Date of birth
*
-
Month
-
Day
Year
Date
Member or guest
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Club name
Membership number
MEDICAL INFORMATION
Is the named participant receiving any mediacal treatment or any prescribed medication?
Yes - if yes, please provide details below
No
Has the named participant ever suffered from any medical conditions (for example) diabetes, asthma, migraine, epilepsy?
Yes - if yes, please provide details below
No
Is the named participant allergic to anything (e.g. antibiotics, penicillin, asprin any medications or any particular foods?
Yes, if yes, please provide details below
No
Does the participant have any disabilities and/or behavioural difficulties?
Yes, if yes please please provide details below
No
Please provide more detail or any other relevant information
EMERGENCY CONTACTS
Please provide details of 2 in case of emergency contacts - available to contact for the duration of the event detailed above.
Name1 - Parent/Guardian
*
First Name
Last Name
Mobile phone number
*
Please enter a valid phone number.
Home phone number
-
Area Code
Phone Number
Name2 - Parent/Guardian
*
First Name
Last Name
Mobile Phone Number
*
Please enter a valid phone number.
Home Phone Number
-
Area Code
Phone Number
DECLARATION
The medical information provided on this form is correct as far as i know and in the event of illness or accident requiring hospital treatment, I give my consent for the named supervisor or equivalent to sign on my behalf any written form of consent required by the hospital authorities, if the delay to obtain my own signature is considered inadvisable by the doctors/surgeon concerned. I understand that the insurance policy made avilable to me via the county office or NFYFC and understand the extent and limitations of the insurance cover provided. I understand that while the adults in charge of the event will take all reasonable care of the young people, they cannot necessarily be held responsible for any loss, damage or injury suffered arising during or as a result of the activity.
Parent/Guardian Signature
*
Parent/Guardian Name completing this form
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Date from completed
*
-
Month
-
Day
Year
Date
I confirm that I have parental responsibily/legal guardianship in relation to this person.
*
Yes
Submit
Submit
Should be Empty: