Organisation Details

Organisation Name

Registered Address

Post Code

Contact Phone Number

Email Address

Email Address (Confirm)

Teacher/Leader's Details

Contact Name

Contact Phone Number

Additional Information

Please give any details you feel may be important for us to meet your group’s individual needs: (Please note that our staff have additional needs training and can make reasonable adjustments to accommodate most people on our activities, but you must inform us prior to your activity).

I confirm that I, the teacher/leader of the group undertaking activities at Dinton Activity Centre have the school/youth group consent forms and medical information for all of the children on the activity on them for the duration of the activity.

I Confirm

I confirm that parents and guardians are aware of the activities taking place and have been made aware of our statement of risk

I Confirm

I confirm I will remain onsite for the duration of the activity and that we are expected to assist in group management of the participants

I Confirm

Photography Consent

We may use your use your photograph, film and words to publicise events, in newspaper articles, magazines and other media such as websites and Intranets, social media, information leaflets, marketing materials such as posters and displays, electronic newsletters and presentations

You can contact Dinton Activity Centre at any point and ask us not to use your photograph, film or words.

Do you consent to the participant being photographed for publicity?

Read our terms and conditions, below.

Terms and Conditions (PDF document)

Terms and conditions

I have read and agree to the terms and conditions.

Signed (Techer/Leader)

Date

Declaration

By ticking this box I consent to the use of my electronic signature in lieu of an original signature on paper.

You do have the right to request that you sign a paper copy instead, however by ticking this box you are waiving that right. You have the right to submit a written request to obtain a paper copy of the electronic form and electronic signature.

Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. Please ensure you update us of any change to your contact details so we can get in touch with any changes, if necessary.

Organisation Details

Teacher/Leader's Details

Additional Information

Photography Consent

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