Buxton Ball 2025 Parental Permission Form

Derbyshire YFC Buxton Ball 2025

Parental Permission to attend the above named activity. This form is to be completed and submitted by the parent/guardian of the members aged 10 to 17 years old. It gives consent for the member to attend and states the details of the individual who will remain responsible for the supervision of that member during the activity. ALL 10 -15 Year old must be accompanied by their OWN Parent(s)/Guardian(s) ALL 16 -17 year old must have a over 18 DFYFC member to be their supervising adult! ALL 10-17 year olds must arrive & depart with their supervising adult
DATE: Friday 19th December 2025

VENUE: The Octagaon, Pavillion Gardens, Buxton, Derbyshire, SK17 6BE

TIME: 8.30pm start carriages away at 1am

Dress Code: Smart/black tie

All members must have access to their current digital membership card (2025-26)

Contact details for the Event are:

County Chair – Rob Webster: 07359477039

County Administrator - Drew Bailey 07915 874399
MEMBER DETAILS

(This section should be completed, signed by parent/guardian and submitted to the event organiser)
Member Name*

Member First NameMember Last Name
Club Name*
Membership Number*
Transport Arrangements:*
Additional information for the event organiser to be aware of? (please detail any current medical or other needs) If NONE just put N/A*
Do you give permission for your child's photo to be taken during the event (as photos maybe uploaded to Our Social media)*
Supervisor for the U 18 member at the Event
Name of supervising Adult (if 10-15 this MUST be the Parent/Guardian Attending on the night)*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Which club are they From? (IF the parent just put your childs club in)*
Membership number of the over 18 (Required if supervising 16-17 year olds)
Please enter a valid phone number.
Relationship to the U18 member *
EMERGENCY CONTACTS

Please provide details of 2 in case of emergency contacts - available to contact during the above activity.
Name1 - Parent/Guardian*

ICE1 First NameICE1 Last Name
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*
Please enter a valid phone number.
Name2 - Parent/Guardian*

ICE2 First NameICE2 Last Name
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*
Please enter a valid phone number.
Parent / Guardian Signature*

Clear
Parent / Guardian Name completing this form*

First NameLast Name
Parent / Guardian Email*
example@example.com
Date form completed*

DayMonthYear
date
Should be Empty:

Derbyshire YFC Buxton Ball 2025

MEMBER DETAILS

Supervisor for the U 18 member at the Event

EMERGENCY CONTACTS