Consent Form – February 2020 October dates: Tuesday 18 Wednesday 19 Thursday 20 Standard day 09:30-16:30 Early Bird 08:00-16:30 Late pick-up 09:30-18:00 Full day 08:00-18:00 Parcipant’s name: ........................................................................................................... D.O.B:................................... School: .................................................................................................................................................................................... Emergency Contacts 1. Name and relaonship to child: .................................................................................................................................. Mobile number: ................................................................ Landline number:................................................................ 2. Name and relaonship to child: .................................................................................................................................. Mobile number: ................................................................ Landline number:................................................................ Does your child have any specific medical condions requiring medical treatment and/or medicaon? No Yes If Yes, give details: .................................................................................................................................................................................................. Any other relevant informaon staff need to be aware of: ...................................................................................... .................................................................................................................................................................................................. .................................................................................................................................................................................................. Consent As part of our commitment to children, young people and their families, we require a completed form for every child and young person by gaining parents/guardians permission before we use any images of them in our markeng literature. Your consent indicates that you are happy for us to use your child’s image or quote. Uses could include photos in leaflets, brochures and other wrien material, videos, CDs, presentaons, East Lindsey District Council & Magna Vitae websites and associated pages on public networking sites. No names will be used in any publicaon. Parental Consent I give permission for my child to parcipate in this workshop I give permission for my child to be photographed, filmed and recorded by Magna Vitae Trust for Leisure and Culture, East Lindsey District Council and its partners Signature of Parent/Guardian:.......................................................................................................................................... Print Name: ................................................................................................. Date: ........................................................... If you would like to receive our latest newsleers, exclusive offers, acvity vouchers and much more, then please ck the box and provide your email address. I agree to Magna Vitae sending me relevant markeng informaon (please ck). Email: ...................................................................................................................................................................................... Your details will not be shared with third party organisaons. Registered Charity No: 1160156 Magna Vitae is a Registered Charity. Charity Number 1160156. A Partner to East Lindsey District Council. February Half Term Full Acvity Days at Meridian Leisure Centre, Louth For 5-11 year olds Holiday Activities T uesday 1 8, W ednesday 19 & Thursday 20 F ebruary 20 2 0 Please hand completed form to the Recepon Team at Meridian Leisure Centre