Tides of Change Registration and Consent Form 2022

Registration and Consent Form 2023

Emergency contact details
Confidentiality

Details on this form will be held securely and will only be shared with Tides of Change Director of Activities and support workers who need this information in order to meet the specific needs of your child.
Details of Child/Young Person
Name of Child/young person*

First NameLast Name
Address*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Child's Date of Birth*

DayMonthYear
Gender*

MaleFemale
Details of Parent/Carer
Name of Parent/Carer*

First NameLast Name
Day time telephone number of Parent/Carer*
Mobile telephone number of Parent/Carer*
Email address for Parent/Carer*

Confirmation EmailPlease enter your email address twice for conformation.
Emergency Contact Information

Alternative adult who can be contacted in an emergency.
Name of Alternative Adult *

First NameLast Name
Relationship to child/young person*
Day time telephone number of Alternative adult*
Mobile telephone number of Alternative adult*
Please confirm if there are any activities that your child can not participate in?*
If yes please give details
Medical Information
Any specific medical conditions requiring medical treatment?*
If yes please give details
Details of medication required (such as painkillers, antibiotics, inhalers, Epipen):*
If yes please give details
Any specific medical condition or disability?*
If yes please give details
Any allergies?*
If yes please give details
Details of any dietary requirements or food allergies (vegan, vegetarian, eggs, celiac, nuts ):*
If yes please give details
Consent information

Please tick the boxes below
I give my consent that if an emergency medical situation arises, the organisation may act as loco parentis. If the need arises for administration of first aid and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances that all reasonable steps are made.*

I have read the above and give my consent
I confirm that I have read or have been made aware of the Tides of Change policies and consent forms concerning:*

Code of conductBeach CodeSafeguarding PolicyAnti-Bullying PolicyCoastal School HandbookPhotography and Filming and use of social mediaFire Safety PolicyCovid 19 Compliance
I can confirm that I, the parent/carer and my child/young person are aware of the Tides of Change Coastal School Code of Conduct, Beach Code and Anti-Bullying policy*

Yes
I have read and understood the above consent form*

First NameLast Name
Date*

DayMonthYear
Todays date
Signature of Parent/carer*
Should be Empty:

Registration and Consent Form 2023

Details of Child/Young Person

Details of Parent/Carer

Emergency Contact Information

Medical Information