EIEIO Challenge NFYFC Parental Consent Form

PARENTAL CONSENT FOR UNDER-18 YEAR OLD MEMBERS TAKING PART IN THE NFYFC EIEIO CHALLENGE

This form is to be completed by the Parent or Guardian of the member named below who is under 18 years of age on the day of taking part in the NFYFC EIEIO Challenge. It gives consent for that member to take part in associated planning and activities as well as responsibility for the supervision of that member to a named individual, when the parent is not in attendance. Where the parent is in attendance they are responsible for their child for the duration of the challenge. If you, as the parent, are attending associated activities, please complete sections 1 and 3 of this form; if your child is attending with a supervising adult please ensure they (the supervising adult) complete section 2.

NFYFC will take responsibility for ensuring the safe running of all its events by working with YFC volunteers. Members’ participation will be in accordance with the NFYFC Safeguarding Policy. In the event of an accident or concern arising involving a member under the age of 18, NFYFC will liaise with the parent or the named individual who is supervising the member. Details on this form will be held securely and will only be shared with staff or others who need this information in order to meet the specific needs of your child.
SECTION 1

Details of under-18 year old member (This section to be completed by the parent/guardian)

Please complete the information below:
Full name of YFC Member*

First NameLast Name
Name of NFYFC Challenge*
Club & County information*

YFC ClubYFC County
Membership number*
Member's email address*
Medical Information

Please provide details below.
Doctor information:*

Doctor's NameDoctor's Contact Number
Has the named participant ever suffered from any of the following conditions: diabetes, asthma, bad period pains, migraine, epilepsy, or any other illness?*

Yes - If yes, please provide details belowNo
Is the named participant allergic to anything (e.g. antibiotics, penicillin, elastoplast, aspirin or any such medicines, any particular food etc.)? ?*

Yes - If yes, please provide details belowNo
Is the named participant receiving any medical treatment or on anyprescribed medication?*

Yes - If yes, please provide details belowNo
Does the participant have any disabilities, additional needs and/or behavioural difficulties?*

Yes - If yes, please provide details belowNo
Details of any medication to be taken, include frequency and any relevantside effects?*
If you answered 'YES' to any of the questions above, please use this section to record further details.*
If you, as the parent/guardian are attending this event please check 'YES' below and proceed to section 3

YES - I am attending this competition finalNO - I am not attending and will supply details of the person supervising my child below
SECTION 2 – Details of the adult nominated by the parents/guardian to supervise the member named above
Full name of Supervisor

First NameLast Name
Email address of Supervisor
.
Club & County information of Supervisor if applicable

YFC ClubYFC County
Contact details & Relationship to member

Mobile phone numberRelationship to competing member
SECTION 3

Information and Emergency Contact Details (This section to be completed by the parents/guardians)
The medical information recorded on this form is correct to the best of my knowledge and in the event of illness or accident requiring hospital treatment I understand that the responsible person at the event will make every effort to contact me*

Yes - I understand
In an emergency doctors/surgeons will make the decision regarding the necessary treatment without my consent*

Yes - I understand
I have read and understood the attached information and give my consent for my child to take part in this event.*

Yes - I understand
I understand that the NFYFC insurance policy is available on request.*

Yes - I understand
I am aware that while the adults in charge of the event will take all reasonable steps to protect all participants from harm, they cannot necessarily be held responsible for any loss, damage or injury suffered during or as a result of the activity.*

Yes - I understand
Do you have parental responsibility and/or legal guardianship in relation to this member?*

YesNo
National Federation of Young Farmers’ Clubs Photographic Consent for under-18 year old members

Occasionally, we may take photographs or commission external companies to photograph or film members participating at our National Federation of Young Farmers’ Club activities, competitions and events on our behalf. When holding virtual events and competitions, the activity, or part of it, may be recorded or a screen shot maybe taken. As part of the YFC activities, such images are used for the legitimate interest of the organisation, which includes promotional activity such as displays, scrapbooks, newsletters, on the website, social networking sites or in publications, and the publishing of competitions results. Live events, competitions or activities may also be visited by the media who will take photographs or film footage, which may lead to members appearing in these images in local or national newspapers, or on televised or internet news programmes. In addition, the winner(s) of any competitions that are run will be announced online and we would like to include a photograph of the winner. In the event that your child is a competition winner, we may ask them to send a photo of themselves for us to include on the winning social media graphic. Videos and photos that are recorded (or submitted) as part of the activity and which include an image of your child may be used, with their name, unless there are safeguarding or other reasons why you do not wish your child’s photograph to be used – please indicate this below. No images will be sold but may be used for external press and news features. All images will be kept for use for a limited time and then only for historical and reference purposes.
I understand that this activity may involve a picture or video of my child and the resulting images or footage could be used by NFYFC in printed or digital(website and social media) format*

YesNo
I consent to my child’s first name accompanying their photograph/images.*

YES - Please include my child's first nameNO - Do not include my child's name
If you would like to discuss your child’s photography permissions, please tick the box. (you will be contacted by a representative of NFYFC)*

Yes - Please call/email me to discuss photography permissionsNo - I do not wish to discuss photography permissions
May we (NFYFC) use your child’s photograph in Young Farmers printed publications that we produce for promotional purposes?*

YesNo
May we use your child’s image on our website?*

YesNo
May we record your child’s image on our video?*

YesNo
Are you happy for your child to appear in the media? (inc press and social media)*

YesNo
I UNDERSTAND THAT I HAVE A RESPONSIBILITY TO INFORM NFYFC STAFF PRIOR TO THE EVENT OF ANY CHANGES TO THIS INFORMATION. If this form is completed incorrectly NFYFC will contact you to ascertain the relevant information.*

Yes - I understand and will provide updated information if necessary
I have read and understood all requirements detailed in the consent form. Signed:*

Clear
Date*

MonthDayYear
Date
Full Name & Relationship to child (In Block Capitals)*
ICE CONTACT NUMBER

Area CodePhone Number
ICE CONTACT NUMBER*
Should be Empty: