Johmard LYME

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Parental Consent Form

Parent / Carer Consent

         I give my consent for my child to attend activities run by The Johmard LYME and for him/her
          to take part in activities on and off site during advertised session hours. I will ensure that my
          child understands that any rules and instructions given by staff must be observed at all times.

         I understand that although staff and volunteers will maintain a high level duty of care, they
          cannot necessarily be held responsible for any loss, damage or injury my son or daughter
          suffers as a result of activities they take part in.

         I undertake to inform the Leader in Charge of any changes in the fitness of my child, which
          may affect any activities they take part in. I give consent for those in charge to give
          permission for my child to receive medical treatment in case of emergency, but only in the
          event that I cannot be contacted or present in time.

         I agree that if my child is responsible for any act which damages premises or equipment, either
    individually or jointly with others; I will accept liability for the costs involved to remedy the damage,
    in proportion to the degree of involvement of my child causing the damage.


         From time to time The Johmard LYME needs to report to funders about individuals taking part in
    its activities. I give consent for The Johmard LYME Project to share my child’s details (in line with
    the Data Protection Act) for the task of statistical data collection only (Please tick).


Yes       No


         I understand that from time to The Johmard LYME may photograph or video events & activities
    for use in promoting the organisation or satisfying our funders that activities have taken place. I
    give consent for these images to be used for these purposes only (Please Tick).


Yes        No


         I understand that it may be necessary to contact my child via SMS or email detailed above, to
    notify or remind them about changes in programmed activities. I give consent for The Johmard
    LYME to do so only when they need to and for no other reason (Please Tick).

       Yes       No



Parent/Carers Name (Print):        __________________________

Signed:                                     __________________________ 

Date:                                        __________________________


Please contact us if you would like a copy of the full policy document.


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