1st Glendermott BB – Annual Consent Form

BB Company

Personal details

Details of the child / young person being registered.

Name of child / young person

Please enter the child's full name.

Known as

Please enter the name your child is known by.

Date of birth

Please enter a valid date of birth.

Age

Please enter your child's age.

School year (P1 – Yr14)

Please select a school year.

Home address

Please enter the full home address including postcode.

Parent / carer details

Name

Please enter your name.

Relationship to child / young person

Please enter your relationship to the child.

Best contact number

Please enter a valid phone number.

Email

Please enter a valid email address.

Emergency contact person

If the parent / carer above is unavailable, who should we contact?

Name

Please enter the emergency contact's name.

Relationship to child / young person

Please enter their relationship to the child.

Best contact number

Please enter a valid phone number.

Medical details of child / young person

Name of GP / practice

Please enter the GP or practice name.

GP contact number

Please enter the GP's phone number.

Does your child have any medical conditions, special needs, allergies, dietary requirements, medication being taken, or anything else that would be helpful for leaders to know about?

Yes No

Please answer Yes or No.

Please give details

Please give details so leaders can support your child.

Health & first aid declaration

I will inform the leaders of any important changes to my child's health, medication or needs and also of any changes to our address or to any of the contact details given above. In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner. If I cannot be contacted and my child should require emergency hospital treatment, I authorise the leadership team to take my child to a suitable hospital. I understand that every effort will be made to contact me as soon as possible.

Do you agree to the statement above?

Yes, I agree No

Please answer Yes or No.

Photographs / video

During the time your child is with us, photographs / video / media recordings may be taken which may be used by the BB Company, Church and/or BBNI for publications or marketing purposes, including in print and online. For this, we need your permission.

Do you consent to photographs / video of your child being used as described?

Yes, I consent No

Please answer Yes or No.

Personal care

Are there any circumstances where assistance may be needed for the personal care of younger or vulnerable boys?

Yes No

Please answer Yes or No.

Please provide details

Please give details.

I give permission for a leader / leaders to provide personal care in the event of a toilet accident.

Yes No

Please answer Yes or No.

I would like to be contacted in the event of a toilet accident.

Yes No

Please answer Yes or No.

Permission & declaration

I give permission for my child to attend and to participate in the activities associated and organised by the BB Company named above.

Yes No

Please answer Yes or No.

I confirm that the information provided is correct to the best of my knowledge and undertake to notify the leader in charge of any changes.

Yes No

Please answer Yes or No.

Print name (signature)

Please type your full name as your signature.

Relationship to BB member

Please enter your relationship to the BB member.

Date

Electronic signature. I confirm that I am the parent / carer named above and that typing my name here constitutes my signature on this consent form.

Please tick to sign the form.

Annual Consent Form 1st Glendermott Boys' Brigade Company

BB Company

Personal details

Parent / carer details

Emergency contact person

Medical details of child / young person

Health & first aid declaration

Photographs / video

Personal care

Permission & declaration

Thank you – form received