O.L.L.Y Consent Form

    Child & Parent/Guardian Details

    Child’s Details









    Child's address









    Parents Details





    Address of parent/guardian









    Telephone & email








    Health Declaration


    MaleFemaleOtherPrefer not to say

    Emergency contact details (2 contacts required)

    Emergency contact 1








    Address



    If no please enter address








    Emergency contact 2








    Address



    If no please enter address









    Please state any other information you think would be useful to us? i.e disabilities or allergies




    Doctor/healthcare information













    Child's medical information

    Are there any disabilities or special needs we need to know about?



    Is your child on any current medication e.g antibiotics etc?



    Does your child have any ongoing medical conditions such as asthma or Hay Fever that require medication?



    Does your child have any other concerns such as fear of dogs, fear of water or bedwetting?



    Does your child have any special diet needs, any foods that need to be avoided?



    Any Medication should be handed to the Session Leader and it will be supplied when needed if the medication needs to be carried your child this must be agreed upon with the organisers.


    Education/school information



    School Contact Details




    Declaration

    All information will be kept confidential; we cannot accept responsibility for any information not declared.

    I, the Parent/Guardian declare all information is correct



    Please sign:



    Promotional/Marketing

    We would like to ask for your permission for your child’s / children’s photo to be taken at any of our sessions or trips out.

    The photos may be used on our website or in our Olly Literature.

    Declaration

    All information will be kept confidential; we cannot accept responsibility for any information not declared.

    I, the Parent/Guardian declare all information is correct

    I give my permission for my child’s photo to be taken at any Olly sessions:


    YesNo

    Child name




    Activities


    SWIMMING APTITUDE

    Please click the box below that best describes your child’s ability to swim:


    Ardent SwimmerAverage yet confident in the waterUnable to swim

    SESSION / DAY TRIPS / HOLIDAYS

    We arrange various session days for your child to participate in as part of the O.L.L.Y project.


    YesNo



    Declaration



    Please sign:



    OLLY Rules

    1. No foul language will be aimed at anyone within our charity.

    2. No abusive language to be aimed at anyone within our charity.

    3. No threatening or abusive behaviour towards anyone within our charity.

    4. No physical abusive behaviour towards anyone within our charity.

    If my child/children do any of the above, I understand that my child will only be given one warning before we will be called into a meeting with the charity to discuss matters.

    I will treat anyone within the charity with respect.





    Please sign:




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