Young Person's Details Young Person's Date of Birth * Young Person's Age * Young Person's Address Postcode * Young Person's Home Telephone Number * Young Person's Mobile Telephone Number * Contact Email Address * Young Person's Ethnicity * How has your son/daughter engaged with ITMP before? * Medical Details Please list any medical conditions that ITMP needs to be aware of, including disability or dietary requirements. * Additional Medical Consent *
During your son’s/daughter’s time engaging with ITMP, if they do not bring with them medication for minor ailments such as headaches, insect bites, blisters, etc. it may be necessary for us to administer medication or plasters. Please tick to give your consent to ITMP providing your son/daughter with any of the above.
I consent to visits to A&E Including any emergency dental, medical or surgical treatment as considered necessary by the medical authorities present in the best interest of your son/daughter’. * I consent to my son/daughter receiving the above necessary medical treatment for any minor injury or illness while engaging with YS. I also confirm that I will contact ITMP if there are any changes to my medical details and my emergency contact details. Parent / Guardian's Details Parent / Guardian's Name * Relationship to Young Person * Your Address * Your Postcode * Your Contact Home Telephone Number * Your Contact Mobile Telephone Number * Your Email Address * Emergency Contact Details Alternative Emergency Contact * Relationship to the Young Person Activity and Involvement Consent As parent/guardian of the above, I have read, fully understood and am satisfied with the details supplied here about ITMP activities and agree to my son / daughter taking part in them * Todays Date * I am happy for ITMP to take photos/films of my son/daughter. * I am happy for ITMP to use photos/films of my son/daughter for internal reports or reports to funders. * I am happy for IMTP to use photos/films of my son/daughter for external publications (brochures, posters, leaflets. * I am happy for ITMP to use photos/films of my son/daughter for web-based publicity (Website, ITMP Social Media). * I am happy for ITMP to engage Online via our virtual youth project with my son/daughter through the use of Social Media platforms (Facebook, Twitter, Instagram, YouTube, Zoom etc) and our website. This will include participating with photos, video (both Live Stream and pre-recorded), posting, comments etc. Please tick as appropriate, the ways you are happy for us to communicate * I am happy for IMTP to contact me (parent/guardian) about our upcoming events, using the contact details provided above. I have read the information about Data Protection, and agree to my son’s/daughter’s personal data being used in the way described above * CONFIRM INFORMATION AND SUBMIT CONSENT FORM *
By ticking ‘Yes’ above, I (parent/guardian), confirm that all the information provided on this form is true, complete and accurate.