Pearson Street APG Consent Form

1

This form is to give consent for a young person to participate in design and construction activities with Build Up.

Build Up is charity that supports young people to design and build community spaces. For more information, visit our website www.buildup.org.uk

2

Young persons name* This field is required.

First Name

Last Name

3

Young persons age* This field is required.

4

Young persons shoe size* This field is required.(For steel toe work boots)

5

Young persons emailTo get in touch about further opportunities

6

Parent / Carer's name * This field is required.

First Name

Last Name

7

Parent / Carer's mobile* This field is required.

8

Parent / Carer's email* This field is required.

9

Please state any known allergies or medical conditions or additional needs that Build Up’s staff should be made aware of

10

I authorise Build Up staff to obtain medical advice in an emergency and give consent for emergency medical treatment for my young person if I cannot be contacted at the time.* This field is required.

Yes

11

I consent for still and video photography to be used to document and promote this project by Build Up and partners involved* This field is required.

Yes

No

12

I give permission for the named young person to take part in the project.* This field is required.Sign here:

Clear

13

Your details will not be given to any third party. Do you wish to be contacted by Build Up in the future:* This field is required.

Yes

No