Jaguar Land Rover Takeover Challenge
In conjunction with Solihull Council
Consent to Participate Form
Student Details
Surname………………………………………… First Names……………………………………………..
Address………………………………………………………………………………………………………….
……………………………………………………………Post Code………………………………………….
Telephone Number…………………..………Mobile Number………………………………………………
Date of Birth…………………………Age………………
.
Information & Participation Statement
Your son/daughter/ward has expressed an interest in taking part in the Jaguar Land Rover Takeover Challenge Work Experience Programme at the Jaguar Land Rover site, Lode Lane, Solihull between 24th and 27th April 2018.
During this programme they will undertake group work, activities and presentations at the on site Education Business Partnership Centre, a tour of the site and 2 days working in an engineering/manufacturing area.
All relevant safety equipment will be provided by Jaguar Land Rover e.g. safety shoes, hi-viz jacket, safety goggles, hard hat.
For more information about this programme please contact Liz Moore on 0121 709 7165 or 07760 392692 or email .
Parent/Guardian Consent
I being the parent/guardian of the young person named above, give my permission for them to attend the Jaguar Land Rover Takeover Challenge Work Experience Programme and undertake the activities arranged during the programme. I give my permission for the responsible officer to have my child’s medical consent form details during this period, after which they will be destroyed.
I understand that I can obtain further information about any of these activities from the contact named above.
Name………………………………………Signature…………………..……………Date…………………
School Consent given by:
Name………………………………………Signature…………………..……………Date…………………
.
Jaguar Land Rover Takeover Challenge
In conjunction with Solihull Council
Emergency Contact and Medical Details Form
Name of student......
Emergency Contact Address/Telephone
Name of Contact………………………………………………....Relationship…………………………………………..
Mobile No………………………………………………Work No………………………………………………
Home No……………………………………………….
Address…………………………………………………………..…………….. Post Code ……………….
Alternative Emergency Contact
Name of Contact…………………………………………………Relationship…………………………………………
Mobile No………………………………………………Work No……………………………………………..
Home No……………………………………………….
Address………………………………………………………………………….Post Code…………………..
Family Doctor
Name……………………………………………………....….Phone No…………………………………….
Address…………………………………………………………………………………………………………
Medical Information
1. Any condition requiring medical treatment, including medication? Yes/No
If yes please give brief details……………………………………………..………………………….
………………………………………………………………………………………………………………..…………………………………………
2. Please outline any specific dietary requirements of the participant and the type of pain/flu medication they may receive if necessary……………………………………………………….…. ………………………………………………………………………………………………………
3. To the best of your knowledge has the participant been in contact with infectious diseases or suffered from anything in the last 4 weeks that may be contagious?
Yes/No
4. Is the participant allergic to any medication? Yes/No….If Yes, which medication?
…………………………………………………………………………………………………………..
5. When did the participant last have a tetanus injection?………………………………….
6. Any other information you feel to be relevant to enable the participant to get the most out of Takeover Challenge?…………………………………………………………………..
………………………………………………………………………………………………………………………………………………………….
During the period 24-27 April 2018 I agree to my son/daughter/ward receiving medical attention and any emergency dental, medical or surgical treatment as considered necessary by the medical authorities present. I understand that officers will always try all emergency home contacts to inform me of the situation but if this is not possible officers will allow medical authorities present to provide the necessary medical attention.
I will inform Liz Moore of any change in their medical condition or other circumstances or their contact details prior to
The Jaguar Land Rover Takeover Challenge Work Experience commencing.
Name…………………………………………Signature…………...... Date………………...
Jaguar Land Rover Takeover Challenge
In conjunction with Solihull Council
Consent form for use of images/video
Your son/daughter/ward has expressed an interest in taking part in the Jaguar Land Rover Takeover Challenge Work Experience Programme at the Jaguar Land Rover site, Lode Lane, Solihull
This could mean that photographs, video and audio materials may be produced from the work they are involved in. These may appear for use in any of the following:
· Audio and Visual Publications and Marketing Materials
· Promotional DVDs/Videos/Displays
· The Solihull Council and Solihull Partnership Websites and their pages on social networking sites
· Local & National Newspapers, Radio Stations and their websites
Under the Data Protection Act 1998, we need your permission before we take and use any images.
Please complete all the sections below, then sign and date the form where shown:
( All sections must be completed)
Details of person(s) consenting to young person being photographed/videoed/recorded:
Name: ______
Address: ______
______
Tel: ______
Email: ______
Name of young person ______
Relationship of consenting person to young person:______
Age and date of birth of young person: ______
NB: - All images/video will be used to promote positive activities only
- This image/video consent form is valid for three years from the below date
- Websites can be viewed throughout the world, not just where UK law applies.
Consent Withdrawal – If you wish to withdraw your consent for any reason please notify Liz Moore on 0121 704 7165 immediately. Please note we will cease to use the image(s), however, printed materials, DVD/Video, and web copy may continue to be in circulation following withdrawals.
I have read and understood this form and give consent for images to be used by Solihull Council, the Solihull Partnership and Jaguar LandRover as indicated above.
SIGNATURE: ______DATE: ______/______/______
YOUR NAME (in block capitals): ______