Parental Consent & Safeguarding Form (Teens)
1. Participant Information
Child's Full Name:
*
Child's Age:
*
2. Parent / Guardian Information
Name:
*
Relationship to Child:
*
Primary Contact Number:
*
-
Area Code
Phone Number
Email Address:
*
example@example.com
3. Emergency Contact (Backup)
Required if the parent/guardian is not remaining on-site.
Name:
*
Relationship:
*
Contact Number:
*
-
Area Code
Phone Number
4. Safeguarding, Supervision & Collection
Safeguarding is a priority at TableTop Tales.
Facilitator:
AccessNI checked and holds full public liability insurance as a Children's Entertainer.
Venue:
Sessions are held at a Unit 1, 2 Tullyreagh Rd, Tempo, BT94 3GJ
Venue operating 24-hour CCTV and Audio Recording.
Supervision:
Sessions are group-based; one-to-one situations are not involved.
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Next
Drop-Off & Collection Policy
It is preferred that a parent or guardian remains on-site.
If leaving, you
must
provide the backup emergency contact above.
You must return within
15 minutes
of the scheduled session end time.
Late Collection Procedure
If a child has not been collected within 15 minutes of the session end time:
The Primary Contact will be called immediately.
If there is no response, the Backup Emergency Contact will be called.
3. The child will remain supervised at the venue until collected.
4. If the child is not collected 30 minutes after the session end time, and no contact can be made with either contact, appropriate safeguarding procedures will be followed. This may include contacting the venue safeguarding lead or relevant local social services.
I have read, understand, and agree to the Safeguarding and Late Collection procedures.
5. Communication & Online Tools
D&D Beyond: May be used for character sheet management.
Discord: May be used for game-related setup or updates (Text & Voice only).
Boundaries: Between-session communication is limited to game-related matters only.
I consent to the use of these tools OR
My child will NOT use online tools (paper alternatives preferred).
6. Medical & Additional Information
Please list any medical conditions, allergies, neurodiversity needs, or information that may help us support your child (e.g., sensory preferences, anxiety triggers):
7. Media & Photography (Select ONE)
Images used for Table Top Tales social media/marketing. Faces are blurred as standard.
YES. (I consent to photos with unblurred/blurred faces).
NO. (No photos of my child).
8. Final Consent & Signature
I confirm that the information provided above is accurate and up to date. I understand that I can raise questions or concerns at any time regarding my child's participation.
Parent / Guardian Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: