Acceptance, Medical and Travel form

Young Person’s Contact Details

Name
Project
Date of Birth (DD / MM / YYYY) / Gender
YP’s Home Tel No / YP’s Mobile No
Email
Address / Postcode:

Arrival at the Venue (YMT advise you to arrive at 9am)

I will arrive by [please circle] / Car Train Bus Tube Taxi
My Parents/Carers will accompany me: / Yes No
Time of arrival at Venue

Departure (we expect the day to finish by 10.30pm)

Time of departure
I will depart by [please circle] / Car Train Bus Tube Taxi
My Parents/Carers will collect me: / Yes No

Acceptance
I hereby accept the place on the project that has been offered to me/my son/daughter* and accept the terms and conditions detailed on this form.

I hereby agree to credit Youth Music Theatre UK (YMT) on any future CV’s and theatrical credits in perpetuity.

I hereby declare that:

Terms and Conditions: Before signing this form I have read, understood, and agree to the Terms and Conditions
Disabilities: I have provided details of any disability that will affect my son's/daughter's* participation in the Project, including any special access requirements.
Photo & Film Release: YMT projects are photographed and filmed for archival and marketing purposes. Images may appear on film, in print and online in perpetuity. I confirm that I give permission for myself/my son/daughter* to be filmed or photographed for these purposes and for these images to be stored and duplicated without further permission being sought.
Medical Matters: I have disclosed in confidence all relevant information about any medical condition, health problem, or allergy which affects me/my son/daughter/*.

Terms and Conditions

Conduct and Attendance: YMT expects participants to be courteous to staff and peers and to respect the needs of others. Participants will be punctual and agree to fully participate in the days rehearsals.
Rules and Discipline: Participants hereby agree that they will accept the authority and guidance of Artistic and Pastoral staff and understand that failure to do so can result in them being sent home.
Insurance: YMT undertakes to maintain only those types of insurance required by law.
Variation: YMT will endeavour to deliver the Project as advertised but reserves the right to change any of the facilities or itineraries, If a major change becomes necessary or is deemed by YMT to be advisable, participants and/or Parents will be informed as soon as is reasonably practicable.
Cancellation: YMT reserves the right to cancel the Project in any circumstances. However, YMT would not do this without good cause.
Legal Contract: The offer of a place and its acceptance by the participant/parents/carer of the Participant give rise to a legally binding contract on the terms of these terms and conditions.
Jurisdiction: The Parties submit themselves to the exclusive jurisdiction of the courts of England and Wales.
DATA PROTECTION ACT (1998) The information you supply on this and future documentation will be stored electronically and/or on paper by YMT and will be used for future correspondence about your project. Details will NOT be passed onto third parties

Medical Information
Emergency Contact Details

Next of Kin’s name
Relationship to young person
Mobile Tel no.
Home Tel no.

Medical Details

Any known allergies (e.g. penicillin, nuts, insect bites)?
Please include details of severity and any relevant treatment/medication.
Special dietary requirements (e.g. gluten free, vegetarian)?
Any medical conditions (e.g. Asthma, Diabetes, Fits, Migraine, Fainting)?
Will the young person be bringing any medication with them? Please give details.
Any potential barriers to participation that we need to be aware of (e.g. dyslexia, ADHD, access issues)
Do you give permission for the pastoral staff to administer paracetamol and/or ibuprofen in the case of need? / Yes / No
Signed by Participant if over 18 / Signed by Parent/Carer for those under 18
I confirm that the information given above is true at the present time and I consider myself to be fit to participate in all YMT activities.
I agree to receive emergency dental, medical or surgical treatment including anaesthetic, inoculation and blood transfusions as deemed necessary by the medical authorities present.
I undertake to inform the Pastoral Manager of any changes to the above information by the start of the project.
I hereby accept the place on the project, and accept the terms and conditions detailed on this form. / I confirm that the information given above is true and I consider the young person named is fit to participate in all YMT activities.
I agree to (name) ………………………………………… receiving emergency dental, medical or surgical treatment, including anaesthetic, inoculation and blood transfusion, as considered necessary by the medical authorities present.
I undertake to inform the Pastoral Manager of any changes in the above information by the start of the project.
….. hereby accepts the place on the project and the terms and conditions detailed on the form
Signed / Signed Parent/Carer
Date / Date

Return this form to The Hub, St Alban’s Fulham, 2 Margravine Road, London, W6 8HJ

or email it to