Falcon Lodge Consent Form | YMCA Sutton Coldfield

Child's Name *

First

Last

Child's Gender *

Child's Date of Birth *

The form doesn't accept special digits. For example, if your child's DOB is 12/06/2010 please just write 12062010

Child's Age *

Child's School *

Child's Home Address *

Please fill out your address including house number, road name, area, city and postcode

Child's Medical *

Asthma, Eczema, Medication, etc.

Child's Disabilities (Please State) *

This includes ADHD, Autism, Sensory Issues etc.

Dietary Requirements *

Please fill this information correctly so we are able to know in advance your child's dietary requirements

Food Allergies or Intolerences

Staff Awareness

Is there anything Staff should be aware of about your child? For Example: My child doesn't eat much throughout the day due to medication

Main Contact Name *

First

Last

Relationship to Child *

Main Contact Telephone Number *

Main Contact Email

Additional Emergency Contact 1 *

First

Last

Please fill out an Additional Emergency Contact details. This person need to be different to the Main Contact but over the age 18

Additional Emergency Contact Relationship to Child *

Additional Emergency Contact Telephone Number *

Consent *

I consent to photos and videos of my child being taken and used for marketing purposes, including website, marketing promotions and social media
I consent to my child being transported in YMCA minibuses and private hire vehicles including coaches or public transport
I agree that my child can make their own way home from The Lodge, Churchill Road, Sutton Coldfield B75 7LB (Over 12s ONLY)
I consent to my child receiving any emergency treatment whilst in the care of YMCA Sutton Coldfield, Compass Support and Birmingham City Council Youth Service, including dental, medical or surgical treatment and administration of anaesthetic. We will always follow the advice of the medical practitioner treating your child and every reasonable effort will be made to contact you and an emergency contact
I agree that the YMCA can share my child's data with Compass Support and Birmingham City Council, their partner organisations at Falcon Lodge, in line with the YMCA Sutton Coldfield Privacy Policy

* Please read each one and tick if you are happy to give your consent ----------- Information Sharing: Compass Support Services is a registered charity (1068324) and the charitable arm of The Pioneer Group. Compass Support Services provides a wide range of community focused services, projects and initiatives to local individuals. The personal information that you provide will be processed safely and securely by Compass Support Services for the purpose of enrolling you on, to ensure that you are appropriately supported and your welfare needs are met. We may, for some fund providers (for example charitable trusts, social funds, educational grants, lottery funding), have to share some of your personal data with them to account for the funds received and to demonstrate the delivery of a specific project. Strict control measures are in place to ensure that only the minimum amount of information is safely shared, and where possible, we will endeavour to remove any information that directly identifies you. For further information as to how Compass Support Services uses, stores and processes your personal information we recommend that you read our Privacy Policy available on our website (www.compass-support.org.uk)

Consent to Contact Your Child (Over 12's Only) *

My child is under 12, please send all details to the Main Contact
I consent to YMCA staff contacting my child, as well as the Main Contact, about Sessions & Trips
I don't want my child to be contacted, please send all details to the Main Contact

* Please read each one and tick the one you are happy to consent to

Child's Number