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Grafham Water Consent Form

Does the above person:

• Have a medical condition requiring medical treatment or medication?*
• Have an allergy to certain medications?*
• Is s/he able to administer her/his own medication?
Does s/he have any special dietary requirements?*
I confirm that my child is water confident and able to swim 25 metres*

HOME AND EMERGENCY CONTACT INFORMATION
(Must be contactable for the duration of the visit / activity)

FAMILY DOCTOR DETAILS

Declaration by person with parental responsibility for the child/young person.

I am satisfied that all reasonable care will be taken for the safety of those participating and that adequate staffing and safety measures have been arranged*
I undertake to inform the group leader of any change in medical circumstances prior to the activity date*
I acknowledge the need for the person named above to behave responsibly and agree to the establishment’s procedures in this respect. In the event that their behaviour is not acceptable, I acknowledge that it is my responsibility to make arrangements for them to be collected and cover any associated costs*
I give permission for my child’s photograph to be taken by others and confirm that any pictures taken by my child will be used for personal purposes only and will not be downloaded to the internet or any social networking websites*