Participant Consents Form

Participant Consents
Participant Media Consent Form
COVEY regularly seeks opportunities to promote its work and showcase the positive impact its services have on children, young people and families. In order to do this effectively, COVEY uses photographs, videos and quotes from our participants and staff.

In accordance with the General Data Protection Regulation (GDPR) and our policy, COVEY will not permit photographs, videos or quotes to be taken or recorded without consent. Participants aged 16 and over can fill in this consent form on their own behalf. However, if the participant is under 16, this must be completed by a parent/carer.

COVEY will take all steps to ensure these images, videos and quotes are used solely for the purposes for which they are intended. The consent granted on this form can be retracted at any time by sending an email to office@coveybefriending.org.uk or calling our office on 01698 894013.
Declaration of Consent

Please read the information on external public sharing and internal anonymised/non anonymised sharing below. Then select Yes or No from the options underneath each.

1. External Public Sharing

I give permission for COVEY to use recorded quotes, videos and photographs of me. I understand that I will be identifiable in these. I understand this information may be used in printed/online publications, presentations and promotional releases, including those outlined below. I understand that I can retract this consent at any time by contacting COVEY using the provided details and that use of my photographs/videos/recorded quotes will cease.

• Leaflets, giving information about our services and opportunities.

• Newsletters, updating our community about latest news and upcoming events/opportunities.

• Case Studies in funder/board reports, detailing the impact of our services.

• Social media platforms, promoting our services, opportunities, and latest news updates.

• Press releases, giving information to local press about our services, opportunities and impact.

• Website, giving information on our services and latest news updates
Your Declaration:

Yes, I give permission to the aboveNo, I do not give permission to the above
2. Internal Anonymised Sharing

I give permission for COVEY to use recorded quotes and information to create anonymised case studies for use in reports (such as funding bids, board reports and project evaluations) to detail the impact of our services. I understand that I will not be identifiable in these.
Your Declaration:

Yes, I give permission to the aboveNo, I do not give permission to the above
3. Internal Non - Anonymised Sharing

I give permission for COVEY to use recorded quotes, information, videos and photographs to create case studies for internal reports to funders and service partners (such as funding bids, board reports and project evaluations) to detail the impact of our services. I understand that I will be identifiable in these.
Your Declaration:

Yes, I give permission to the aboveNo, I do not give permission to the above
I am:

The ParticipantThe Parent/Carer of the Participant:
Participant Name:
Participant Signature:

Powered by Jotform SignClear
Parent/Carer Name:
Parent/Carer Signature:

Powered by Jotform SignClear
COVEY Staff Member Name:
COVEY Staff Member Signature:

Powered by Jotform SignClear
Date of Declaration:

DayMonthYear
Date
Consent to Share Information
For what purpose is my information shared?
Sharing information about adults and older people in community care settings is crucial for providing effective support, helping us to work across agencies.

Similarly, "Getting it right for every child" (GIRFEC) is a Scottish policy focused on improving the well-being of children and young people by ensuring they receive the right support at the right time. A key aspect of GIRFEC is the responsible and ethical sharing of information between different agencies and professionals who work with children.

The aim of sharing information is to source and provide the right support for people at the right time. However, this sharing of information must be done with careful consideration of your privacy and consent.
What information will be shared?
For adults and older people, this information includes:
- Referrals
- Assessments
- Outcome Plan
- Service Request
For children and young people, this information includes:
- Request for Assistance
- Chronology
- Assessments
- Child/Young Person's Plan
What agencies will share my information? (relevant agencies to be selected by COVEY staff member)

HealthSocial WorkEducationHousingPoliceOther AgencyOther Person
If 'other' agency or person was selected above, please specify below:
Exceptions to my information being shared between the Agencies selected above:
The reasons why this information is going to be shared, what is being shared and with whom have all been fully explained to me by:
Name of COVEY Staff Member:

First NameLast Name
I have also been provided with the following information:

The Adult’s Leaflet – You and Your InformationYoung People’s Leaflet – You and Your InformationInformation Sharing for Parents and CarersInformation on annual review of my consents (or at my request)
I am:

The ParticipantThe Parent/Carer of the Participant
I agree to allow their information to be shared between the above agency/agencies.

Yes, I agreeNo, I do not agree
I agree to allow my information to be shared between the above agency/agencies.

Yes, I agreeNo, I do not agree
Participant Name:

First NameLast Name
Participant Signature:

Powered by Jotform SignClear
Parent/Carer Name:

First NameLast Name
Parent/Carer Signature:

Powered by Jotform SignClear
Date

DayMonthYear
Date
Medical Outing Consent
Participant's Name:

First NameLast Name
Participant's Date of Birth:

DayMonthYear
Date
Participant's COVEY Project

ANGELS - Teen TransitionsANGELS - Young AdultANGELS - East KilbrideANGELS - ClydesdaleBuilding Brighter FuturesNL Befriending ServiceIntandemRural BefriendingFlourishing FamiliesParent Partnership ProjectCOVEY Family Support
Do you suffer from any allergies?

YesNo
Details relating to allergies:
Do you have any medical condition, or additional need that we need to be aware of?

YesNo
Details relating to medication condition or additional need:
I consent to participating in events, outings and activities with COVEY. I understand that all planned activities will only take place at venues approved by COVEY who will have carried out relevant risk assessments.

Yes, I agree to the aboveNo, I do not agree to the above
I understand that COVEY must share information with Social Work and/or emergency services if a child or adult is at risk of harm.

Yes, I agree to the aboveNo, I do not agree to the above
I consent to receiving emergency medical treatment, should it be required, when with COVEY staff. I also consent to COVEY holding the following medical information, in the event that treatment or additional support is required.

Yes, I agree to the aboveNo, I do not agree to the above
I understand it is my responsibility to ensure that any required medication is brought on any outing with staff. I also understand it is my responsibility to ensure the medication is in date. In the event of a medical emergency COVEY cannot be held responsible for the absence of the required medication.

Yes, I agree to the aboveNo, I do not agree to the above
I am:

The ParticipantThe Parent/Carer of the Participant
Participant Signature:

Powered by Jotform SignClear
Parent/Carer Name:

First NameLast Name
Parent/Carer Signature:

Powered by Jotform SignClear
Emergency Contact Details
In case of an emergency, please insert the name and details of someone whom COVEY can contact - it is your responsibility to ensure that the emergency contact knows that their details have been given to COVEY.
Emergency Contact Name:

First NameLast Name
Emergency Contact Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number:
Relationship to Participant:
Doctor Details
Doctor's Name:

First NameLast Name
Surgery Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Surgery Phone Number:
Should be Empty:

Participant Consents

Participant Media Consent Form

Consent to Share Information

For what purpose is my information shared?

What information will be shared?

Medical Outing Consent

Emergency Contact Details

Doctor Details