Dorset YFC & SWA Competition Parental Consent Form 2023/2024

PARENTAL CONSENT FOR COMPETITION ENTRIES FOR UNDER-18 YEAR OLD MEMBERS 2023/24

Competition Name

Please list the competition above

This form is to be completed by the Parent or Guardian of the member named below who is under 18 years of age on

please insert date of competition/event

It gives consent for that member to attend the event and the responsibility for the supervision of that member to a named individual, when the parent is not attendance. Where the parent is in attendance they are responsible for their child for the duration of the event. If you, as the parent, are attending 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 the venue management and our own team of staff and stewards. Members’ attendance 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 members (this section to be completed by the parent/guardian with the under 18 members details

Competition Name*

Full Name of YFC Member*

Date of Birth*

Name of YFC Club*

YFC Membership Number

New YFC Membership Number 2023/2024

Name of County Federation*

Dorset YFC

Medical History

Name of doctor*

Doctors Tel Number*

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

YesNo

If yes please give details

Is the named participant allergic to anything (e.g. antibiotics, penicillin, elastoplast, aspirin or any such medicines, any particular food etc.)?*

YesNo

If yes please give details

Is the named participant receiving any medicaltreatment or on any prescribed medication?*

YesNo

If yes please give details

Does the participant have anydisabilities, additional needs and/or behavioural difficulties?*

YesNo

If yes please give details

Details of any medication to be taken, includefrequency and any relevant side effects?*

YesNo

If yes please give details

Any other relevant information we need to be aware of (e.g. Medication):

If you, as the parent/guardian are attending this event please click the box and proceed to section 3

Parent Attending

Section 2 - Details of the adult nominated by the parents/guardian to supervise the member named overleaf (This section to be completed by the supervising adult)

Nominated Adult Details

	Please answser to all questions below in full
Name of person to supervise under 18 Member:
Membership Number (if applicable):
County Federation (if applicable);
Mobile telephone number:
Relationship to under 18 year old member: please specify: friend, family member, etc.

Signature of supervising Member

Date

Section 3 - Information and Emergency Contact Details (This section to be completed by the parents/guardians)

Please click to confirm

The medical information overleaf is correct to the best of my knowledge and in the event ofillness or accident requiring hospital treatment I understand that theresponsible person at the event will make every effort to contact meIn an emergency doctors/surgeons will make the decision regarding the necessary treatmentwithout my consentI have read and understood the attached information and give my consent for my child to takepart in this eventI understand that the NFYFC insurance policy is available on request.I am aware that while the adults in charge of the event will take all reasonable steps to protect allparticipants from harm, they cannot necessarily be held responsible for anyloss, damage or injury suffered during or as a result of the activity

Signature of parent/guardian

Date

Full Name of Parent/Guardian (Block Capitals):*

Address*

Street Address

Street Address Line 2

TownCounty

Postcode

Do you have parental responsibility and/or legal guardianship in relation to this member?

YesNo

Emergency Contacts

Please complete in full*

	Name	Tel (Home)	Tel (Work)	Mobile
Parent/Guardian
Parent/Guardian

Please click below

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	No
our printed publications?
our website?
our video?
our social media?
the media?