FRM - Consent Form

1. Young person’s details

Name: *

Age: *

Home address: *

2. Parent or carer’s details

Parent Name: *

Telephone number: *

Home address: *

Email *

3. If there’s an emergency, please contact (only fill in if different from the person named above):

Name:

Telephone number:

Home address:

4. Any extra help we need to provide (for example because of a disability):

5. Do we need to know about any medical conditions or allergies? (If yes, please provide details for the condition(s) and any medication needed)

Information for parents and carers

UK Reads aims to provide a safe and enjoyable experience for every child or young person. To help us do this, please note the following important information.

All questions on the consent form must be completed and signed by the parent or carer before any child takes part.
Parents and carers must ensure they notify us of any changes to the information given on the form.
Parents and carers must accompany their children for the duration of the activity
We cannot take responsibility for any damaged clothing and/or personal items during the activity.
Parents and carers should ensure children have sufficient water, food, clothing, sun lotion and medication (where appropriate) for the duration of the activity.

I agree to (please tick by clicking on the box): *

my child taking part
UK Reads keeping a record of this form for health and safety reasons
any medical treatment that my child may need being given in an emergency
my child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity.

Note: if consent is not given, UK Reads will not use any images taken during the activity that contain the child/young person. I understand that my child needs to follow the behaviour code and any safety rules so that UK Reads can keep them and other children safe

Print name *

Date *

Signature *

Get in touch

Suite 225 – 46 Eversholt Street
London NW1 1DA United Kingdom
Tel: +44 7 842930125
info@ukreads.org
Charity No. 1154264

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