Pirate Castle Individual Consent Form

CONSENT FORM FOR YOUTH / ADULT ACTIVITIES

This consent form must be completed for all individuals wishing to participate in The Pirate Castle’s paddlesport / outdoor activity sessions, school holiday schemes and club activities (which may include canal and land-based activities).

Forms for children ages 8 - 17 must be completed by a parent or legal guardian ONLY. Adults (ages 18+) must complete their own form.

Emergency contact details must be provided for ALL participants.

We will process the personal data you provide to us in accordance with our Data Privacy policy which is available on our website: click here.

We also need to collect data for reporting to our funders. All personal data is anonymised for reporting purposes.
Activity / Session Date (enter first attendance date if signing up for multiple sessions)*

DayMonthYear
Session Date
Activity Type (select from the list below)*

Holiday Scheme (Youth Activity)Term-Time After School / Saturday Paddlesport (Youth Activity)Free Splash Paddlesport Taster Session (Youth Activity)Adult Paddle Club (Adult Activity)Rainbow Paddlers (LGBTQ+ Adult Activity)Upperdeckers (over 50s Adult Activity)Community Group BookingPrivate Youth Group BookingPrivate Adult / Corporate Group BookingSunday Youth Paddlesport (Youth Activity)
Name of Group / Organisation (if attending as part of a group booking) *
E.g. Jane Smith's birthday; Jones Family; ABC Limited etc.
Participant's Full Name*

First NameLast Name
Participant's Home Address*

Street Address

Street Address Line 2

Town / CityBorough / County

Postcode
London Borough (county if non-London resident)*
e.g. Camden
Participant's Age*
Enter the participant's current age. The minimum age for paddlesport is strictly 8 years.
Participant's date of birth (minimum age 8 years for paddlesport activities)*

DayMonthYear
Participant's Gender:*

FemaleMaleNon-BinaryI prefer to self-describePrefer not to say
Which one of these best describes the participant's background or race?*

White (British or English)White (not British or English)MixedAsian or British AsianBlack or Black BritishOther Ethnic GroupPrefer Not to Say
Has the participant attended The Pirate Castle's activities previously?*

YesNo
Which activity / activities has the participant previously attended at The Pirate Castle? Select all that apply:*

Holiday Scheme (Youth Activity)Pirate Club: After School / Saturdays (Youth Activity)Free Splash Paddlesport Taster Session (Youth Activity)School Group ActivityCommunity Group ActivityAdult Paddle Club (Adult Activity)Rainbow Paddlers (LGBTQ+ Adult Activity)Upperdeckers (over 50s Adult Activity)Private Youth Group ActivityPrivate Adult / Corporate Group Activity
Our Charity's community projects and services are externally funded and / or subsidised through private hire of our services. Most of our funders focus on delivering outcomes for the target groups listed below. To help with our reporting and chances of securing future grants, please select which of the option(s) below apply to the named participant (select all which apply):*

Is from a low-income family and / or experiencing financial hardshipIdentifies as LGBTQIA+Is from an under-represented / minority communityHas additional learning / support needsIs deaf or has other physical / sensory disabilitiesExperiences mental health issuesHas been, or is at risk of being excluded from school / collegeIs not in education, employment or training (NEET)Has been, or is associated with gangs or impacted by exploitationIs experiencing, or has been impacted by domestic violence or abuseIs experiencing homelessnessIs a refugee or asylum seeker, or a newly-arrived migrantHas a social worker (including being in the care system, a care leaver and / or has a protection plan)Is a Carer / Young CarerNone of thesePrefer not to say
HEALTH CONDITIONS, DISABILITIES &/OR ADDITIONAL SUPPORT NEEDS Please state any medical conditions (e.g. asthma, diabetes, heart conditions, mobility restrictions etc.), known allergies (antibiotics, aspirin, nuts etc.), disabilities and / or additional support needs that we need to be aware of in the box below. If any medication is required, please bring it to the activity and make staff aware of dosage / usage instructions. Although we cannot provide 1:1 SEND support, we'll always do our best to include individuals with low / moderate support needs where safe and appropriate. We recommend that support requirements are discussed in advance with The Pirate Castle's staff to establish requirements and feasibility. *
Enter N/A if the participant has no health conditions, disabilities or additional support needs
Is the participant authorised to travel home alone after the activity ?*

YesNo - will be collected by the parent / guardian or authorised individual (name to be provided to The Pirate Castle staff if not indicated on this form)
We may take photos or film those participating in The Pirate Castle’s activities for training purposes and / or for The Pirate Castle’s fundraising / promotional use. I give consent for the named participant to feature in publicly accessible images, footage and / or audio*

YesNo
Parent/ Guardian Full Name (youth participants only)

First NameLast Name
Main Contact Number (Parent/Guardian or Adult Participant). Please include the area code*
Main Contact Number
Main Contact Email (for adult participant or parent / guardian of youth participant) *
Emergency Contact Name*

First NameLast Name
Emergency Contact Number. Please include the area code*
Main Contact Number
Alternative Emergency Contact Name*

First NameLast Name
Alternative Emergency Contact Number. Please include the area code*
Main Contact Number
CONSENT DECLARATION

I accept that The Pirate Castle's minimum age for paddlesport / outdoor education activities is strictly 8 years due to public liability insurance and Health & Safety considerations. I confirm that the named participant is aged 8 years or above.

I accept that paddlesport and / or outdoor education activities are assumed risk sports and confirm that I am aware of the risks involved. I have read and understood the advice given on water quality, as stated in the Important Information section below;

In the event of illness / medical emergency involving the named participant, I give permission for treatment to be administered by a nominated First Aider and / or by a suitably qualified medical practitioner as deemed necessary. If I cannot be contacted and the participant should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment / medication and convey the participant to hospital. I understand that every reasonable effort will be made to contact me as soon as possible;

I accept that The Pirate Castle has no responsibility for the security and wellbeing of the participant's personal property at any time;

I accept that individuals will not be permitted to participate in activities without appropriate footwear or kit, as stated in the Important Information section below;

I accept that the participant must follow the rules, instructions and decisions made by The Pirate Castle's staff and instructors at all times and must act in a responsible and civil manner, so as not to cause offence nor restrict the safety, learning and / or enjoyment of other participants or waterways users. Non-compliance will result in the participant being excluded from the activity and may be asked to leave the premises.

Parents / Legal Guardians for youth participants must be available to collect the named participant at the time specified on the booking and / or in the event that the participant needs to leave the premises for any reason, unless they have been authorised to leave on their own. The Pirate Castle must be notified in advance if the participant is to be collected by a third party, whose full name must be confirmed by email (info@thepiratecastle.org) or telephone (020 72676605).

Emergency Contacts must be available to be contacted at any time should a situation involving the named participant arise whilst undertaking activities or attending The Pirate Castle.
I, being the adult participant or the parent / guardian of the youth participant named on this form, state that the information provided is correct. I accept all of the stated terms and have read and understood the Important Information provided (see below). I duly provide consent for the named individual to participate in The Pirate Castle's activities*

I AGREE
Date of form submission*

DayMonthYear
Date
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KIT LIST & IMPORTANT INFORMATION - PLEASE READ

Kit List for paddlesport - ideally participants arrive in their paddling clothes to maximise time on the water:

For paddling:
- Comfortable tops / bottoms (leggings / jogging bottoms / shorts etc.) + t-shirt / fleece / hoodie - ideally synthetic layers (no jeans or swimwear)
- Securely fitting footwear e.g. old trainers / pumps / walking style sandals / wet / beach shoes (no flip-flops or Crocs)
- A neck strap for glasses (if worn)
- Sun cream (in the event of hot weather)
- Hat (sunhat or warm hat depending on the weather)
- Medication (where required - we provide dry bags for participants to keep any medication with them at all times)For afterwards:
For afterwards:
- A complete change of clothes including footwear / underwear
- A towel
Holiday Scheme participants also need to bring a packed lunch: no nuts, sweets and / or fizzy / energy drinks in line with our Healthy Heating Policy.

The duration of all Paddlesport / Outdoor Education sessions includes a Bankside Briefing and Paddle Talk, getting all members of the group kitted out and into / out of their boats.

Participants must arrive promptly to ensure that activities commence at the scheduled start time. Latecomers cannot be admitted once the instructor / group have departed from The Pirate Castle's interior.

Consent Forms & Attendee Lists

A separate consent form is required for each participating individual. Consent forms MUST be submitted to The Pirate Castle at least 48 hours prior to the scheduled start of the activity. Individuals will not be able to participate unless their consent form has been recieved.

Forms for under 18s must be completed by their parent / legal guardian. Adults may sign their own Consent Form. Schools / Community Groups should use the Group Consent Form and sign 'in loco parentis' when parental consent has already been provided for activities undertaken through the named school / community group.

Water Quality and Weil's disease

It is a common misconception that the canals and rivers around London are dirty and full of potential health risks due to water-borne contaminants. In fact, most recreational users (canoeists, kayakers, sailors, canal boat cruisers etc.) will use these stretches of water for many years without experiencing any complaints. However, it is important to understand that waterways/bodies of water can never be sterile environments and that, on rare occasions, people may become unwell due to water-borne contaminants or bacteria.

The Pirate Castle’s team will always endeavour to avoid contaminated areas. We will never practice any skills, play games or splash about in areas identified as contaminated. Visible contaminants can be easily avoided whilst on the water, however as unseen bacteria and microscopic contaminants may be present it is important that all participants take precautionary measures to reduce the risk of becoming unwell following water exposure.

Outlined below is guidance for minimising the risk of contracting Weil’s disease. Following these steps will equally reduce the risk of potentially contracting other water-borne illnesses.

To reduce the risk of becoming ill following water-based activities:
- Cover ALL scratches / cuts / sores / skin affected by eczema with waterproof plasters;
- Have a shower, or at the very least wash your face and hands after each activity session and particularly before eating, drinking or touching your face;
- Avoid capsizing boats or splashing other participants / waterway users unless specifically advised by the instructor team i.e. during wet games;
- Don’t put wet ropes or other objects in your mouth;
- Don’t go in the water without suitable footwear
Weil’s disease or Leptospirosis is a VERY RARE illness. It is carried in the urine of infected animals, particularly rats. The main danger is that because it is so rare, doctors may not recognise it immediately. If you suffer from ‘flu-like symptoms, jaundice or conjunctivitis after you have been participating in water-based activities, you are advised to go straight to your doctor. Tell them you’ve participated in water sports and insist that they check for Weil’s disease and prescribe a suitable course of treatment.

ALWAYS SEE A DOCTOR IF YOU FEEL UNWELL AFTER WATER SPORTS & STATE THAT YOU HAVE BEEN PARTICIPATING IN CANAL-BASED ACTIVITIES
The Pirate Castle
Gilbey's Wharf, Oval Road
London, NW1 7EA

Tel: 020 72676605
email: info@thepiratecastle.org

Flying the flag for opportunity & adventure on the Regent's Canal since 1966!

Registered Charity:1138787 Company Limited by Guarantee:07370167
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