Parental Consent & Acceptance of Risk Form

Dear Parent/Guardian,

Your childhas been invited to attend the GRIPADVENTURE Programme.We require your consent to allow your child to take part under the supervision of our qualified and experienced staff.

As part of the GRIP programme we have planned a series of activities and visits which could include adventurous and outdoor activities. All staff have and fully accept, a duty of care to make those activities as safe as is reasonably practical. However, adventurous activities are inherently hazardous and cannot be completely risk free however hard we try. Accidents can happen without any contributory negligence from GRIP or its staff.

Moreover, the environment we use is such that we cannot “fence off” all hazardous areas. Your child must therefore help our staff to look after their safety by listening carefully to instructions, by doing what they are asked to do and by not being reckless. Only give your consent if you are confident that they will behave responsibly in this way. GRIP can accept no responsibility for loss of or damage to personal property or for personal injury not arising as a result of its own action.

Potential activities could include :1. Swimming & Water Sports

2. Hill Walking & Mountaineering

3. Mountain Biking, BMX & Off Road Riding

4. Indoor & Outdoor Climbing

5. Bushcraft & Survival Skills, Archery

6. Community Engagement Activities

Parent/Guardian Consent

I understand and accept the above statements. My child is fit for the programme and I will inform GRIP of any special medical conditions that might affect my child’s safety.

By signing this form Igive full consent to my child being photographed and filmed during the above activities, which may be used to display positive images on registered web sites or social media.

  1. I agree to my child taking part in the above activities.
  2. I understand that the staff responsible for the activities will take all reasonable care of participants.
  3. I acknowledge the need for my child to behave responsibly.
  4. I consent to any emergency treatment necessary. I therefore authorise the party leaders to sign, on my behalf, any written form of consent required by the hospital authorities should medical treatment (a surgical operation or injection) be deemed necessary, provided that the delay required to obtain my signature might be considered, in the opinion of the doctor or surgeon concerned, likely to endanger my child’s health or safety.

Signature ______Date ______

Print Name ______Relationship to child ______

Participant Details

Name ______Class or Tutor Group ______

Age ______Date of Birth ______

Address ______

______Postcode ______

Tel. No.______or ______

Alternative Contact Name, Address, and Tel. No. (For emergency use) ______

______

______

Personal Information

Please give details requested below or any personal information which might be relevant.

  1. Has your child, to your knowledge, been in contact with any infectious illnesses in the last three weeks? YES/NO

If yes, give details ______

______

  1. Does he/she suffer from any medical condition, illness or disability?(eg. Diabetes, Migraine, Epilepsy, bad period pains) YES/NO

If yes, give details ______

  1. Is he/she allergic or sensitive to anything? (eg. Penicillin, Asprin, Elastoplast, or any other medicines, wasp stings, nuts or any other foods etc.) YES/NO

If yes, give details ______

  1. Is he/she receiving any medical treatment at present?YES/NO

If yes, give details ______

  1. Date of last tetanus injection? ______
  1. Does he/she have any special dietary needs? ______

______

  1. Can he/she swim 50m?YES/NO
  1. Name, Address & Phone number of Doctor ______

Blank Parental Consent