CONSENT FORM Child’s Name: ......................................................................
Date of Birth: ............................................
Home Address: .............................................................................................................................................. .............................................................................................
Post Code: .......................................................
Emergency Contact Name & Tel. Number: ................................................................................................................................ Email: ..................................................................................
School Attended: ....................................................................
Please list allergies and statement of special needs, etc: ........................................................................................................... I consent to my son/daughter’s participation in beach festival organised activities. I undertake to see that my son/daughter attends with appropriate clothing. I permit my son/daughter to be transported in departmental minibuses. To the best of my knowledge, my son/daughter is medically fit to participate in the activities involved and I undertake to inform you in advance of any alteration to this position. I consent to my son/daughter being given emergency medical treatment. My son/daughter is water confident and is able to participate in water based activities. Parent Name: ................................................................
Please ensure your son or daughter brings a completed consent form with them to the sports development event trailer on the day. Data Protection Law (Jersey) 2005 The information provided by you on this form is required by the Education, Sport and Culture for the purpose of activity enrolment and safety requirements. Children’s information supplied by you may be disclosed to sports coaches.
SD 7 - May 2014
Parent’s Signature: ......................................................... Date: ......................................................................................