DofE consent form | Pins & Needles

Please complete the short consent form below. If you have any questions or need to know anything in advance, get in touch with us!

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CONSENT FORM

Student's First Name

Student's Last Name

Student's School

Student's Year + Class

Date of birth

Parent/Carer's First Name

Parent/Carer's Last Name

Phone number

Medical Information - Please declare any conditions you feel we should be aware (medications, allergies or SEN)

I give my consent for the administration of first aid for my child (named above) and, where necessary, the seeking of medical advice and/or emergency treatment

Authorisation for my child to be photographed during these sessions and for these photos to be used responsibly by Pins & Needles to advertise and promote the business. Please note: we never use children's names alongside their photos.

Photo permission

Yes

Signed by Parent/Carer (Initials)

Date

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