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PARENTAL CONSENT FORM (Under 18s) NAME OF PARENTS/CARERS Ger Burchell NAME OF YOUNG PERSON DATE OF BIRTH: [Dyoa Burcche tl \% oi (ql EMAIL ADDRESS: dyn bak 91 om. PHONENO: 07415 O4Kagg EMERGENCY CONTACT DETAILS: OTAKU AO YOUNG PERSON MEDICAL INFORMATION ANY ALLERGIES: Nie ANY SIGNIFICANT MEDICAL/PERSONAL INFORMATION: N\A DOCTOR SURGERY: WEN Surgecy DECLARATION: oa 1, lagree that my child may participate in the activity. 2. lagree that my child is fit to participate and know of no medical reasons or other reasons why he/she should not participate. 3. I consent to any emergency medical treatment that may be necessary if the emergency contact cannot be contacted. 4. lunderstand that my child taking part in this activity, will do so at his/her own risk. 5. agree that my child will comply with my activity provider's instructions whilst carrying out the activity. 6, | accept that Weston College/.. will not be held responsible for any injury, loss or damage to my child or his/her Property during the activity, - !give permission for any photographs or filmed footage of my child to be used by Weston College Media Department for publicity material . | hereby give Weston College my permission to license any images/filmed footage of my child and use them in any Media and for any purpose (except pornographic or defamatory) which may include, among others, advertising, promotion, marketing and packaging for any Product or service. | agree that the images/filmed footage of my child may be combined with other images, text and graphics, and cropped, altered or modified as needed. General Data Protection Regulation The content we are capturing will be used by Weston College Group for educational purposes and/or promotional marketing material for the college. By signing this document | agree for the Weston College Group to licence the. content and use the image/video taken, your childs name and (if applicable) ‘any agreed testimonial for the duration of the following (tick all that apply): Prospectus (2 years) Posters (3 years) Website (5 years) Social Media (permanently) Film (5 years) Adverts (3 years) Banners (5 years) News and PR (permanently) © All of the above vet Parents/Carers Signature: GG ~

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