Professional Documents
Culture Documents
Consent Form: Re: TW YFC and SPY's Residential Trip
Consent Form: Re: TW YFC and SPY's Residential Trip
The cost of the trip is 15 per young person; this includes everything transport,
accommodation, food, and activities! But we are limited to 30 spaces, which will be issued on
a first come, first serve basis.
Yours sincerely,
CONSENT FORM
SARAH FARNES
Youth Worker
St. Philips, Birken Road
01892 531031
sarahjf69@live.co.uk
ROSIE CONROY
Senior Youth Worker
Tunbridge Wells YFC (on behalf of No1)
28 Church Road, 01892 458 101
rosieaconroy@gmail.com
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Medical Information
My son/daughter is in good physical health and I consider him/her fit to participate.
YES/NO
YES/NO
___________________________________________________________________________
Does your son/daughter have any know allergies? (If yes, please give details)
YES/NO
___________________________________________________________________________
Doctors Name: _________________________________ Doctors Tel No:
Doctors Address:
_____________________________
___________________________________________________________________________
Declaration
I agree to my son/daughter receiving medication as instructed and any emergency dental,
medical or surgical treatment, including anesthetic or blood transfusion, as considered necessary
by the qualified medical authorities present.
Consent for Photos to be taken
During childrens events, photographs and/or video recordings may be taken and used in publicity
materials or in the local press but will not include names or addresses of young people for security
reasons. If you have no objection to photographs/video recordings being used for the above
purposes, please sign below, which confirms your agreement.
Signed: ______________________________
Date: __________________