1. health and fitness
2. disease
3. allergies

Fun Alive Club | Consent Form
PLEASE NOTE: All children should bring this form with them on their first day at Fun Alive
Club. A separate form must be completed for each child. ALL FIELDS MUST BE COMPLETED.
Name of Child ………………………………………………………………………..................................................................................................
Address ………………………………………………………………………………....................................................................................................
………………………………………………………………………………………….........................Post Code…………………………………………..
Date of Birth ………………………..…………...........……………Home Contact No ..………………………..................................................
Name of parent........................................................................... Tel No ...........................................................................................................
Email …………………………………………………………………………………………………………………………………………………….………
Emergency Contact Name……………………………………......……..………Tel No ………………………..................................................
(If different from above)
Please indicate your wishes about your child leaving Fun Alive Club:
(PLEASE DELETE AS NECESSARY)
I will always collect my child/
My child is able to leave the club unaccompanied.
Does your child have any of the following? If so, please give details in the box provided below:
1.
2.
3.
4.
5.
7.
8.
Any medical condition?
Any special needs?
Any food allergies?
Any other allergies e.g. face paints, sun cream?
Currently taking any medication?
Belong to a specific faith group?
Have special dietary needs?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Please provide full details if you have answered yes to any of the above questions. When the forms have been
collated then a member of staff from the club will contact you to discuss the matter fully.
In the event of an emergency then every effort will be made to contact the parent/carer or emergency contact
but should these efforts fail I consent to any emergency treatment that should be absolutely necessary.
Name of child’s GP ………………………………………………………………………………………………………………………………………
GP’s telephone number ………………………………………………………………………………………………………………………………
Staff may take photographs of the children for training or funding purposes, please indicate as required.
I do/ do not consent to my child being included in photographs.
I confirm that all the information contained on this is form are true and accurate and I realise that any false
details on this form cannot be held against the Hybu Ltd Organisation in the event of an accident or emergency
should the false information prevent parental contact or the correct treatment.
I consent to my child taking part in the activities on offer at Fun Alive Club.
Signed …………………………………………………………….……. Parent/Carer
Date…………………………………………
Please print name clearly …………………………………………………………………………………………………………………………