Social Parental/ Guardian Consent Form
Activity:    LOCK - IN                                              Date of Activity: 15th February 2008 - 16th February 2008

Venue: Christ Church Clifton, Bristol
 
Transport: make your own way to venue

Cost: £5 includes entrance, and food (not tuck shop)
 
Time:  8pm til 8am  
Name of child:                                                                             Age:                                         D.O.B:

Address:                                                                                     Home Tel: 

                                                                                                  Mobile:

 

Does your child have any medical conditions we should be aware of?    YES/NO (if yes please state what they are) 

 

Is your child taking any medication? YES/NO (if yes please state the full name of the medication)

 

Doctors Name & Address:                                                               Tel:

 

 
Emergency Contact Details (Name, Address & Tel):

 

 
 
I hereby give permission for my son/daughter named above to take in the said activity under the supervision of the leaders and for any photographs and video material taken during the activity to be used for future publicity. In case of illness or accident I authorise...

1) The leader of the activity to sign on my behalf any written form of consent required by medical authorities if a delay in obtaining my signature is considered inadviseable or unecessary by the doctor or surgeon.

2) The leader to administer prescribed and non-prescribed medication

Signed:

Name:                                                                                            Date: