PARENTAL GUARDIAN CONSENT FORM
1st SEPTEMBER 2015 – 31st AUGUST 2016
Dear Parent/Guardian
All young adults under the age of 18 years must have parent/guardian permission before joining a Young Farmers’ Club. Activities will include club meetings, outside visits, competitions, training, sports and social events. The club will be involved in Cornwall
County Events, at Harvest Festival, Indoor Sports, Carol Service, Competitions Day, Royal
Cornwall Show, Rally, Country Fair, Sports Day, discos and dances, most of which are included in the club programme (available from Club Secretary).
MEMBERS DETAILS:
Name:

Club:

Date of Birth:

Age of Joining:

Address:
Post Code:
Contact Telephone No/Mobile:
EMERGENCY CONTACT DETAILS:
1) Name:
Address: (If different to above)
Post Code:
Telephone Home:

Work:

Mobile:

2) Name:
Address: (If different to above)
Post Code:
Telephone Home:

Work:

Mobile:

MEDICAL HISTORY:
Name of Doctor:
Address:
Post Code:
Telephone No:
Cont.d …….

I/We confirm that our young adult DOES NOT suffer from any medical condition requiring regular treatment.
I/We confirm that our young adult DOES suffer from (Diabetes, Asthma, Migraine, Epilepsy or any other illness)
YES/NO (If YES please provide details)

Is your young adult allergic to anything? (antibiotics, penicillin, elastoplasts, aspirin or any such medicine)
YES/NO (If YES please provide details)

TRANSPORT:
I/We give permission for transport to be provided by a Young Farmer/Associate Member of either sex to and from meetings, visits, County and National events. Dates/times can be sought from the club secretary but could be subject to change.
Signature of Parent/Guardian: …………………………….. Date: ……………………………..
PHOTOGRAPHY/VIDEOING:
Occasionally, we may take photographs of the members at our Young Farmers’ Club activities; these may be used by ourselves for promotional purposes, displays or scrapbooks. They may also be supplied to NFYFC for use in newsletters, on the website or the Ten26 publication.
The club may also be visited by the media who will take photographs or film footage of high profile events. Members may appear in these images which could appear in local or national newspapers, or on televised news programs.
Please complete the details below to indicate your consent to be photographed and for these images/films or audio to be used by your young farmers’ club and at a national level. We will use the name of the young person to accompany images unless you state otherwise. May we use your child’s photograph in Young Farmers printed publications that we produce for promotional purposes?
May we use your child’s image on our website?
May we record your child’s image on our video?
Are you happy for your child to appear in the media?
Are you happy for your child’s name to accompany any of the above?

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

Signature of Parent/Guardian: …………………………….. Date: ……………………………..
I/We have read and given the required information above and hereby give my/our consent for ……………………………..(insert name of member) to be a participating member of …………………………….. YFC and Cornwall Federation of Young Farmers'
Clubs until 31st August 2016.
Signature of Parent/Guardian: …………………………….. Date: ……………………………..