Y Sort It Consent Form 2020 – 2021 Y SORT IT CONSENT FORM If you are human, leave this field blank. SERVICES ACCESSED Please select the services that your child / young person attends (please select all accessed) * YOUNG CARERS MENTORING YOUTH GROUPS STREETBIKES OtherOther YOUNG PERSON'S DETAILS Young Person's Last Name * Young Person's First Name * School Young Person's Age * Young Person's Date of Birth * Young Person's Address * Young Person's Address Young Person's Address Young Person's Address City City Young Person's Address Postcode Postcode PARENT / GUARDIAN / CARERS DETAILS Parent / Guardian / Carer First Name * Parent / Guardian / Carer Last Name * Relationship to Child/ Young Person * Parent / Guardian / Carer's Email Address Parent / Guardian / Carer's Phone Number * Address If Different From Above Address If Different From Above Address If Different From Above Address If Different From Above City City Address If Different From Above Postcode Postcode EMERGENCY CONTACT DETAILS - MUST BE DIFFERENT FROM DETAILS ABOVE First Name * Last Name * Relationship to Child/ Young Person * Emergency Contact Number HEALTH DETAILS Does your child have any allergies / illnesses or additional support needs? * Yes No Does your child have any special dietary requirements? * Yes No Does your child require medications? * Yes No If YES, to any of the above please give details - EMERGENCY CONSENT - PLEASE READ AND TICK AS APPROPRIATE Emergency Consent * Yes, In an emergency & I cannot be contacted, I GIVE CONSENT to any emergency/medical/surgical/dental treatment which my child my require, including anaesthetic No, In an emergency & I cannot be contacted, I DO NOT CONSENT to any emergency/medical/surgical/dental treatment which my child may require ACCESS & ACTIVITIES AGREEMENT AGREEMENT * I agree my child can participate in a range of activities provided by Y Sort It I do not agree my child can participate in a range of activities provided by Y Sort It TRAVEL TO AND FROM ACTIVITIES AGREEMENT * I WILL ensure my child is brought to & collected from Y Sort It activities either by a Parent / Guardian/ Carer I ALLOW my child to make their own way to and from Y Sort It activities ONLINE / DIGITAL YOUTH WORK ONLINE / DIGITAL YOUTH WORK * I agree to my child being involved in digital youth work online with Y Sort It including interacting with staff and other young people via Y Sort It social media platforms I do not agree to my child being involved in digital youth work online with Y Sort It including interacting with staff and other young people via Y Sort It social media platforms ONLINE / DIGITAL YOUTH WORK RECORDED ONLINE SESSIONS * I consent to my child being involved in recorded online calls while they are involved in Y Sort It sessions I do not consent to my child being involved in recorded online calls while they are involved in Y Sort It sessions PHOTO, VIDEO & MEDIA CONSENT Please note that any photos or videos taken may be used as promotional material on the Y Sort It / West Dunbartonshire Council website, for press and / or social media purposes. * I consent to my child being photographed / filmed while they are involved in Y Sort It sessions I do not consent to my child being photographed / filmed while they are involved in Y Sort It sessions DATA PROTECTION DATA PROTECTION - The information will be kept safe and secure in a paper form and computer file. It will be kept on a shared database with access by all coordinators and management. Your child can see the information we hold at any time. The information will not be shared externally without seeking permission, unless there is mitigating circumstances. * I GIVE permission for this information to be stored on both paper and computer format I DO NOT GIVE permission for this information to be stored on both paper and computer format BY HITTING THE SUBMIT BUTTON YOU ARE AGREEING TO THE ABOVE INFORMATION BEING ACCURATE AND AGREE TO THE USE OF THIS INFORMATION AS SET OUT ABOVE Submit
