Youth Consent Form

    To be completed for participants under 18 years and distributed with an information sheet/letter giving full details of the visit.

    The Council is committed to keeping your personal information safe and secure and keeping you informed about how we use your information. To learn about how your privacy is protected and how and why we use your personal in formation to provide you with services, please visit our service privacy notice here www.rctcbc.gov.uk/serviceprivacynotice and the Councils data protection pages data protection pages here www.rctcbc.gov.uk/dataprotection.

    Please read the declaration below and complete the form to continue:

    Declaration

    • Having read the information about the visit, and having understood the level of supervision to be provided, I agree to my child taking part in the visit and activities described.
    • I understand that all reasonable care will be taken of my child during the visit/activity and that he/she will be under an obligation to obey all directions and instructions given and observe all rules and regulations governing the visit/activity.
    • I understand the code of conduct for the visit and the sanctions that may be used if my child breaks this code of conduct. I have discussed the code of conduct and sanctions with my child.
    • I understand that if my child seriously misbehaves or is a cause of danger to him/herself or to others, then I may be asked to collect him/her or he/she may be brought home early from the visit/activity. In such a situation there will be no obligation on the school/centre to refund any money.
    • In an emergency I agree to my son/daughter receiving medication and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present, unless stated otherwise in the box below.
    • I understand RCT may use activity images for promotional or publicity purposes, unless otherwise stated in the box below.
    • I understand the extent and limitations of the insurance cover provided.
    • I understand that the information provided on the consent form will be stored by Rhondda Cynon Taf County Borough Council, who are the Data Controller. It will only be used to organise and provide the services requested, to aggregate and evaluate the effectiveness of the service and to inform and aid the planning and development of future services.

    We will only share identifiable information outside of Rhondda Cynon Taf County Borough Council in the event that the wellbeing of your child is at risk. You can request copies of the information we hold by writing to RCTCBC, Principle Information Management and Data Protection Officer, Bronwydd House, Bronwydd Avenue, Porth, Cf39 9Dl.

    Please note that all fields marked with an asterisk (*) are required.

    Youth Club

    Your Details

    Support Needs, Medical & Dietary

    ADHDAutismTourettesFASDDyslexiaDCD/DyspraxiaSensory Processing IssuesOCDLearning DifficultiesConduct DisorderODDAnxietyDepressionRegular MedicationSupport in SchoolOther

    Water confidence/swimming ability

    Please indicate your child's swimming ability:

    Additional Details

    Your Contact Details

    Alternative emergency contact

    Family Doctor

    Declaration

    Declaration – please note Yes or No to each of the following statements

    Having read the information about the club and having understood the level of supervision to be provided, I agree to my child taking part in the provision. I understand that all reasonable care will be taken of my child during the provision and that if he/she does not follow the rules and instructions of a staff member, they will be asked to leave.

    I give permission for a qualified first aider to provide First Aid to my child should he/she have a minor accident. I understand that in the case of an emergency, emergency services will be contacted.

    I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) producing and storing imagery/video of my child and that all copyright of the imagery/video shall remain with RCTCBC.

    I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) using the imagery/video for future promotional purposes on Council outdoor media, Council websites, and Council social media accounts, Council digital and print publications.

    I consent to the Youth Engagement and Participation Service (Rhondda Cynon Taf County Borough Council) sharing the imagery/video with local and/or national media.

    You can change your mind any time about your child’s image being used. If you want to change your mind, please contact us - YEPS@rctcbc.gov.uk

    Completion

    If you do give consent to us to photograph your child for social media and marketing purposes, please tick this box I do give consent

    When you fill in this form, we'll temporarily store your data so we can respond to your enquiry (Legitimate Interest Legal Basis under GDPR). For full details, please see our Privacy Policy.

    Thank you, your form has been successfully received.