Youth Consent Form To be completed for participants under 18 years and distributed with an information sheet/letter giving full details of the visit. The Council is committed to keeping your personal information safe and secure and keeping you informed about how we use your information. To learn about how your privacy is protected and how and why we use your personal in formation to provide you with services, please visit our service privacy notice here www.rctcbc.gov.uk/serviceprivacynotice and the Councils data protection pages data protection pages here www.rctcbc.gov.uk/dataprotection. Please read the declaration below and complete the form to continue: Declaration Having read the information about the visit, and having understood the level of supervision to be provided, I agree to my child taking part in the visit and activities described. I understand that all reasonable care will be taken of my child during the visit/activity and that he/she will be under an obligation to obey all directions and instructions given and observe all rules and regulations governing the visit/activity. I understand the code of conduct for the visit and the sanctions that may be used if my child breaks this code of conduct. I have discussed the code of conduct and sanctions with my child. I understand that if my child seriously misbehaves or is a cause of danger to him/herself or to others, then I may be asked to collect him/her or he/she may be brought home early from the visit/activity. In such a situation there will be no obligation on the school/centre to refund any money. In an emergency I agree to my son/daughter receiving medication and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present, unless stated otherwise in the box below. I understand RCT may use activity images for promotional or publicity purposes, unless otherwise stated in the box below. I understand the extent and limitations of the insurance cover provided. I understand that the information provided on the consent form will be stored by Rhondda Cynon Taf County Borough Council, who are the Data Controller. It will only be used to organise and provide the services requested, to aggregate and evaluate the effectiveness of the service and to inform and aid the planning and development of future services. We will only share identifiable information outside of Rhondda Cynon Taf County Borough Council in the event that the wellbeing of your child is at risk. You can request copies of the information we hold by writing to RCTCBC, Principle Information Management and Data Protection Officer, Bronwydd House, Bronwydd Avenue, Porth, Cf39 9Dl. Please note that all fields marked with an asterisk (*) are required. BackNext Youth Club Please select your youth club below Ynys ViewFernhillDarran LasGwerniforGlyncochIlanBryn CelynnogGarth OlwgTreorchyTon and GelliFerndaleYnyshirCapel FarmLlanhari Your Details Support Needs, Medical & Dietary Does your child have any of the following (please choose) ADHDAutismTourettesFASDDyslexiaDCD/DyspraxiaSensory Processing IssuesOCDLearning DifficultiesConduct DisorderODDAnxietyDepressionRegular MedicationSupport in SchoolOther If other, please give details Please give details of any regular medication taken by your child Please tell us how anything ticked above could affect them during the activity Does your child have any physical or medical conditions? YesNo If yes please tell us about them and what support they will need on the activity Please give details of any allergies Please give details of any special dietary requirements of your child Please give details of any recent illness or accident suffered by your child that staff should be aware of Please list any types of non-prescription medication or lotions your child may not be given To the best of your knowledge, have you been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be contagious or infectious? YesNo If Yes, please give details When did your child last have a tetanus injection? BackNext Water confidence/swimming ability Please indicate your child's swimming ability: Cannot swimAble to swim a little in a swimming poolAble to swim confidently in swimming poolAble to swim confidently outdoors (e.g. lake, river or sea) Additional Details Is there anything you would like staff to know about your child to help them make the most of this Provision? Your Contact Details Alternative emergency contact Family Doctor BackNext Declaration Declaration – please note Yes or No to each of the following statements Having read the information about the club and having understood the level of supervision to be provided, I agree to my child taking part in the provision. I understand that all reasonable care will be taken of my child during the provision and that if he/she does not follow the rules and instructions of a staff member, they will be asked to leave. YesNo I give permission for a qualified first aider to provide First Aid to my child should he/she have a minor accident. I understand that in the case of an emergency, emergency services will be contacted. YesNo I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) producing and storing imagery/video of my child and that all copyright of the imagery/video shall remain with RCTCBC. YesNo I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) using the imagery/video for future promotional purposes on Council outdoor media, Council websites, and Council social media accounts, Council digital and print publications. YesNo I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) sharing the imagery/video with local and/or national media. YesNo You can change your mind any time about your child’s image being used. If you want to change your mind, please contact us - YEPS@rctcbc.gov.uk Completion If you do give consent to us to photograph your child for social media and marketing purposes, please tick this box I do give consent Please provide any other relevant information or requests regarding your child's booking below, this could include changes to the declaration made at the top of this form When you fill in this form, we'll temporarily store your data so we can respond to your enquiry (Legitimate Interest Legal Basis under GDPR). For full details, please see our Privacy Policy. Back {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. 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