Doc 2 – Parental/Guardians Consent Form

Insert (IWIBA, Club Name)

Parental/Guardians Consent Form

Information on this form will be held in confidence.
(This form can be changed/adapted by changing items in RED
for use by IWIBA/Club as required)

I give permission for ……………………………………………………………………………….. to travel and
participate in all activities/Event Name ………………………………………………………………………….
……………………………………………………………………………………………………………………………………..
Designated Safeguarding Officer …………………………………………………………………………………..

Full Name:

Address:

 

Home Tel No:                                                                       Parents Mobile No:

Date of Birth:                                                                         Age: 

 

Additional Emergency Contact:  

Name:                                   Relationship:                          Mobile No:

 

GP/Doctor’s Name:                                                              Telephone No:

Details of any known special dietary requirement/allergies/medical conditions:

 

Any other special needs, requirements, directions, that would be helpful for the team manager to know about:

 

I will inform the coaches/designated safeguarding children officer of any important changes to my child’s health, medication or needs and also of any changes to our address or phone numbers given. In the event of illness, having parental responsibility for the above named child, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication.

I have been made aware that the Irish Women’s Indoor Bowling Association (IWIBA) have developed a Safeguarding Children and Vulnerable Adults Policy and a Code of Conduct.

The IWIBA or Club is committed to ensuring that any information gathered in relation to above Junior player meets the specific responsibilities as set out in the Data Protection Act 1998.

I confirm that all details are correct to the best of my knowledge and I am able to give parental consent for my child to participate in & travel to all activities. By returning this completed form, I agree to my daughter/child in my care taking part in the activities – for example timing and transport details.

I understand in the event of injury or illness all reasonable steps will be taken to contact me and to deal with that injury/illness appropriately but also if there are any changes in circumstances that are relevant at home that we will inform the IWIBA/Club (for example illness or injury).

Signature of Parent/Guardian*………………………………………………………………………..
Print Name ……………………………………………………………………………………………………
Signature of Child ………………………………………………………………………………………………………………………………………………………………………………………………………..

* Parental consent is defined by the Children(NI) Order 1995 Article 6 (I)
Natural mother always has parental responsibility.
Natural father gains parental responsibility:
* If married to the mother at the time of birth or subsequently marries her
* Through an agreement witnessed by solicitor or a Parental responsibility Order
* Post 15 April 2002 if they jointly register the baby’s birth.