Parental Consent and Medical Form

You must fully complete the form below in order to allow the applicant to participate in the activities organised by West Yorkshire Police listed below:

  • The Explorers Programme
  • Public Order Training
  • Neighbourhood Team patrol attachment

The contents of this form are standard for any activity where West Yorkshire Police staff have responsibility for the supervision of young people.

This form will be retained by District

Name of applicant ______

Relationship to applicant ______

Behaviour and Risk

  • I agree to the applicant taking part in the activities named above. I have been informed about what the activities involve and agree to his/her participation in these activities
  • I authorise the police officers or other qualified staff to act on my behalf in ensuring the welfare of the applicantwhilst in the care of West Yorkshire Police
  • I understand that whilst every care will be taken by the staff, they cannot be held responsible for any incident or accidents that arise out of the unreasonable behaviour of the applicantor other members of the group. I understand that if the applicant’s behaviour is unreasonable, he/she may be removed from the activity.
  • A proper Risk Assessment with regard to Health and Safety legislation has been made in relation to the activities that form part of the programme. A copy is available if required.
  • I agree to the applicant receiving emergency medical treatment as considered necessary by the medical authorities present.

Is there anything you wish to make us aware of that would prevent the applicant from taking part in any part of the Explorer Programme?

______

______

Address

Telephone/mobile number

Emergency contact number

Second contact:

Name

Address

Telephone/mobile number

Name and address of family doctor

Surgery telephone number

Media Coverage

I consent/do not consent to the applicant being involved in media coverage of Explorers.

Newspaper YES/NO

Advertising and Marketing YES/NO

Internet/Social Media YES/NO

Radio and Television YES/NO

Signature of parent/guardian

Date

Please print your name and relationship to the applicant.

Name of applicant

ALL OF THE ABOVE INFORMATION WILL BE TREATED IN THE STRICTEST CONFIDENCE

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