Appropriate Adult Consent FormPermission to participate in the LGBTQ Youth Cornwall activities / events 1. I agree to the below named child taking part in LGBTQ Youth Cornwall activities / events for 3 years form the date below.2. I undertake not to hold LGBTQ Youth Cornwall, or any of its representatives responsible for compensation in respect of loss or damage to personal property, which theysustain during the activities.3. I understand the importance of advising the group of any medical or special needs which they may require particular attention in order to enable my child’s full and safe participation in the events.4. I understand not to permit them to attend the visit if he/she is not in good health or has been in contact with an infectious disease within 2 weeks of the commencement of the visit.5. If at any point of the visit, they require urgent medical treatment, and provided that I cannot be contacted personally, I give my permission to the medical authorities to administer such emergency treatment, including anaesthetic, as they consider necessary in the circumstances.6. I understand that if they cause harm or serious upset to a member of the group or to a member of staff, that it is my responsibility to collect them from the activity/event.Name of Child / Young Person _______________________________________________Date of Birth __/__/__Please give full details of any pre-existing medical conditions, allergies or any medication the child / young person is currently taking continuing overleaf if necessary____________________________________________________________________________________________________________________________________________________________________________________Name of GP ___________________________________________Your Name ____________________________ Relationship to child / young person _______________________Please give two emergency telephone numbersI give full permission for the child / young person to attend activities and events with LGBTQ Youth Cornwall.Signed _________________________________ Date __/__/__
YAYConsentform2011.doc.pdf
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