Clone of Christmas Ball 2024 Parental Consent Form

Parental Consent Form - Christmas Ball 2025

This form is to be completed by the Parent or Guardian of the member named below who is under 18 years of age on 19th December 2025. It gives consent for that member to attend CDFYFC's Annual Christmas Ball and the responsibility for the supervision of that member to a named individual, when the parent is not attendance. County Durham Federation of Young Farmers' Clubs will take responsibility for ensuring the safe running of all its events by working with the venue management, volunteers and staff. Member’s 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, County Durham FYFC 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 volunteers, staff or other organisations that may 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)
Name of Member*

First NameLast Name
Club*
Select your YFC club from the drop-down list
Membership Number*
Please specify your membership number
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Doctors Surgery*
Address of Doctors Surgery*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact number of Doctors Surgery*
Do you have any of the following?*

Health conditionsDisabilitySEN (Special Educational Needs)AllergiesDietary requirementsOther additional needs (please specify below)None
Any other relevant information we need to be aware of (e.g. medications): Please give details.
Section 2

Details of the adult nominated by the parents/guardian to supervise the member named (This section to be completed by the supervising adult)
Name of person to supervise under 18 member:*

First NameLast Name
Membership number (if applicable)
Club (if applicable)
Mobile number of supervising person*
Relationship to u18 member*
Please specify: friend, family member, etc.
Signature of supervising member*

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Date of signature*
Section 3

Information and Emergency Contact Details (This section to be completed by the parent/guardian)
Parental signature

The medical information above 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. In emergency doctors/surgeons will make the decision regarding the necessary treatment without my consent. I have read and understood the attached information and hereby give my consent for my child to take part in this event. I understand that the YFC member 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 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.
Signature*

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Date of signature*
Full name of parent /guardian*

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

YesNo
Emergency Contacts

Please provide contact information for at least one parent or guardian in case of an emergency
Name (parent/guardian)*

First NameLast Name
Contact telephone number 1*
Contact telephone number 2*
Name (parent/guardian)

First NameLast Name
Contact telephone number 1
Contact telephone number 2
Section 4

Photography Permissions (This section to be completed by the parent/guardian). As part of the YFC activities, pictures and videos are used for the legitimate interest of the organisation which includes promotional activity and the publishing of competitions results. Official event photography and video from the event will include your child unless there are safeguarding or other reasons why you do not wish your child’s photograph to be used, please indicate this below. All events will display information regarding the capturing of images and who to speak to if there are any concerns during an event. 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.
Please tick one*

I understand that at this event my child may be photographed/filmed taking part and the resulting images or footage could be used by NFYFC in printed or digital (website and social media) format with their name accompanying.I would like to discuss my child’s photography permissions (you will be contacted by a representative of County Durham FYFC)
I understand that I have a responsibility to inform County Durham FYFC prior to the event of any changes to this information. If this form is completed incorrectly County Durham FYFC will contact you to ascertain the relevant information.
Should be Empty:

Parental Consent Form - Christmas Ball 2025

Section 1

Section 2

Section 3

Parental signature

Emergency Contacts

Section 4

I understand that I have a responsibility to inform County Durham FYFC prior to the event of any changes to this information. If this form is completed incorrectly County Durham FYFC will contact you to ascertain the relevant information.