Family Fun Activity Day 2018: Consent Form
This form must be completed before children (under 18 years) are able to take part in activities. All information you supply will be regarded as confidential.
Please hand the completed form to a member of White Hall Centre staff, who will issue children with a wrist band to indicate they can take part in activities.
General Information
Name of child(ren)
Date(s) of birth Age(s) Male / Female
Parent / carer email address
How did you find out about Family Fun Activity Day? (Please circle/tick all that apply)
White Hall Centre Facebook White Hall Centre Twitter White Hall Centre website School/group
At White Hall CentreAn events listing website
Derbyshire County Council (DCC) Facebook DCC Twitter DCC employee newsletter
Flyer returning with a child from a school trip Banner in the local area Other (please state):
Parental / Guardian Information
Name Parent / guardian
Mobile phone number
Email address (if you would like to be kept up to date with activities and events at White Hall Centre)
Declaration
I agree to my son / daughter / young person in my care to take part in all activities at White Hall Centre’s Family Fun Activity Day. I have read the supplied ‘Parental Information’ form in regard to activities and safety and know of the inherent risk that exists in outdoor adventurous activities; although I understand that these activities will be safely managed – sometimes by parental or adult supervision. I have also been made aware of the need for sensible behaviour by participants and that unacceptable behaviour may result in my child being unable to participate.
YES / NO
I understand that it is my responsibility to let White Hall Centre staff know if there are any medical, behavioural or emotional needs that may affect my child / young person in my care whilst taking part in activities
YES / NO
I understand that photographs will be taken during this event to be used for publicity purposes by White HallOutdoor Education Centre and Derbyshire County Council. I will alert the photographer should I not wish photographs to be taken.
YES / NO
Parent / guardian signature ______Print Name ______
White Hall Centre, Long Hill, Buxton, Derbyshire, SK17 6SX
Telephone 01298 23260 Email Website