PARENTAL & MEDICAL CONSENT FORMMontgomery YFC

IF YOU AREIF YOU ARE UNDER 18 YEARS OF AGE UNDER 18 YEARS OF AGE PLEASE GET YOURPLEASE GET YOUR PARENT/GUARDIAN TO COMPLETE AND SIGN THEPARENT/GUARDIAN TO COMPLETE AND SIGN THE

FOLLOWING DECLARATIONS:FOLLOWING DECLARATIONS:

NameName (in full) (in full) ……………………………………………………………….……………………………………………………………….

YFC ClubYFC Club ……………………………………………………............……………………………………………………............

YFC Membership numberYFC Membership number ……………………………………………… ………………………………………………

Address Address ……………………………………………………………….……………………………………………………………….

……………………………………………………………….……………………………………………………………….

……………………………………………………………….……………………………………………………………….

Home TelHome Tel ……………………………………………………………….……………………………………………………………….

Mobile TelMobile Tel ……………………………………………………………….……………………………………………………………….

Date of birth ………………………………………………………………. Age ………………………………….. Male / FemaleDetails of Parent / Responsible adult who can be contacted in Details of Parent / Responsible adult who can be contacted in an emergency:an emergency:NameName (in full) (in full) ……………………………………………………………….……………………………………………………………….

AddressAddress ……………………………………………………………….……………………………………………………………….

……………………………………………………………….……………………………………………………………….

Home TelHome Tel ……………………………………………………………….……………………………………………………………….

Mobile TelMobile Tel ……………………………………………………………….……………………………………………………………….Driver NameDriver Name ……………………………………………………………….……………………………………………………………….

Driver Tel NoDriver Tel No ……………………………………………………………….……………………………………………………………….

Signature (member)Signature (member)………………………………………………………….………………………………………………………….

Montgomery YFC reserves the right to carry out spot checks onMontgomery YFC reserves the right to carry out spot checks on these forms. Parents will be contacted to ensure this form hasthese forms. Parents will be contacted to ensure this form has

not been falsified. Membership records will be checked.not been falsified. Membership records will be checked.

Checked byChecked by

Permission to consent to Medical treatmentPermission to consent to Medical treatmentThe medical information given is correct as far as IThe medical information given is correct as far as I know. know.

In the event of an accident or illness YFC will liaise with the parent and will make every effort to contact parents.

In the event that I cannot be reached in an emergency,In the event that I cannot be reached in an emergency, I hereby give my permission to the physician, selectedI hereby give my permission to the physician, selected by YFC acting on my behalf, to hospitalise or treat myby YFC acting on my behalf, to hospitalise or treat my son/daughter, including proper anaesthesia, injectionson/daughter, including proper anaesthesia, injection or surgery. In the event of illness or any accidentor surgery. In the event of illness or any accident requiring emergency treatment of my son/daughter, Irequiring emergency treatment of my son/daughter, I authorise Montgomery YFC (agent acting on theirauthorise Montgomery YFC (agent acting on their behalf) to sign on my behalf any written form ofbehalf) to sign on my behalf any written form of consent required by hospital authorities, if the delay toconsent required by hospital authorities, if the delay to obtain my signature is considered inadvisable by theobtain my signature is considered inadvisable by the doctor or surgeon concerned.doctor or surgeon concerned.Transport:Transport: I am happy for my son/daughter to be I am happy for my son/daughter to be transported by a member of YFC, of either sex, to andtransported by a member of YFC, of either sex, to and from the event, if applicable.from the event, if applicable.

SignatureSignatureParent/Guardian Parent/Guardian ……………………………………………………………………………………………………

Name of Parent Name of Parent ……………………………………………………………………………………………………

Date Date ………………………………………………………………………………………………………………See http://www.yfc-montgomery.org.uk/ for details

and YFC Dance Posters

By purchasing a ticket the following shall constituteBy purchasing a ticket the following shall constitute contractually: a parent or guardian has given youcontractually: a parent or guardian has given you permission to attend an event and you agree to givepermission to attend an event and you agree to give your consent for all photography, filming and to beyour consent for all photography, filming and to be searched on arrival.searched on arrival.

NO UNDER 16s at YFC DANCES in Montgomery NO UNDER 18 Non MEMBERS @ MYFC DANCES I give my consent for my son/daughter to attend this event. I understand that the insurance policy is made available

to me via the County Office or Montgomery YFC and understand the extent and limitations of the insurance cover provided.

I understand that while the organisers in charge of the event will take all reasonable care of the young people, they cannot necessarily be held responsible for any loss, damage or injury suffered arising during or as a result of them attending.

I am aware that there is a licensed bar and no Under 18’s shall be served alcohol. Please ensure your son/daughter is aware of the law and does not try to purchase alcohol.

Anyone in possession of alcohol, or anything we deem unsuitable to be taken into the event will have these items confiscated.

Montgomery YFC operates a strict NO DRUGS policy at all YFC events. Anyone who arrives intoxicated, in our opinion, will not be allowed in and parents will be called to arrange collection. It is important to note that lighting effects in use may contain strobe lighting and anyone sensitive to this should take

the appropriate action applicable to their condition. Most importantly, Montgomery YFC wants everyone to have a good time, but we want people to do this sensibly and

safely. We reserve the right to refuse entry on any grounds