ESFA Consent form

Confidentiality

Details on this form will be held securely and will only be shared with coaches or others who need this information in order to meet the specific needs of your child

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Personal information – child / young person

Child Name

Address

Date of birth

Gender

Male Female

Are there any activities in which your child can not participate?

No Yes

Yes Please give details

Do you need any arrangements put in place to manage any specific requirements for your child’s religious beliefs?

No Yes

Yes Please give details

Personal information – parent / carer

Parent Name

Contact No

Emergency contact information

Name of alternative adult to contact in an emergency

Relationship to child / young person

Contact number(s) of alternative adult

Medical information

Are there any specific medical conditions requiring medical treatment?

No Yes

Yes Please Gives Details

Details of medication required

Are there any other medical conditions or disabilities to be aware of?

No Yes

Yes – please give details

Do they have any allergies?

No Yes

Yes – please give details

Are there any dietary requirements (including vegan / vegetarian)?

No Yes

Yes – please give details

I confirm my registration – child / young person

Signature

Print name

Today’s date

Declaration of consent – parent / carer

Please tick the boxes below and then sign this form.

I give my consent that if an emergency medical situation arises, the organisation / club may act in loco parentis for administration of first aid and/or other medical treatment that in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances all reasonable steps will be taken

I confirm that I am happy for my child is to take part in Summer Football Camp activity.

Signature

Print name

Today’s date

ESFA Photography And Filming Consent Form

MYC London will take all steps to ensure these images are used solely for the purposes for which they are intended. If you become aware that these images are being used inappropriately, please inform us immediately.

Images/Videos will be taken by MYC London Media team and will be used on our website and social media channels. All Images will be stored on the Media team secured Google Drive.

MYC LONDON will ensure that no faces will be included in any photos/videos.

Name Of Child

Age

Declaration of consent – parent / carer of child under 16

Please tick each box (or strike out what you do not consent to), then sign this form.

I give permission for my child’s photograph to be used within other printed publications.

I give permission for my child’s photograph to be used on the association’s website.

I give permission for my child’s photograph to be used on the club’s social media channels.

I give permission for video of my child to be used on the association’s website.

I give permission for video of my child to be used on the association’s social media channels

I confirm that I have read, or been made aware of, how these images or videos will be stored within the organisation.

Signature

Today's Date

Print Name

ESFA Photography and filming consent form

In accordance with our safeguarding policy, we will not knowingly permit direct photographs, video or other images of young people to be taken without consent*. If the child is under 16, consent must be obtained from a parent / carer. *Due to the nature of the sport, young people may be indirectly being in the shot of a photo or video/livestream of an event. MYC London will take all steps to ensure these images are used solely for the purposes for which they are intended. If you become aware that these images are being used inappropriately, please inform us immediately. Images/Videos will be taken by MYC London Media team and will be used on our website and social media channels. All Images will be stored on the Media team secured Google Drive. MYC LONDON will ensure that no faces will be included in any photos/videos.

Name of child

Age

Declaration of consent – parent / carer of child under 16

Please tick each box (or strike out what you do not consent to), then sign this form.

I give permission for my child’s photograph to be used within other printed publications. I give permission for my child’s photograph to be used on the association’s website. I give permission for my child’s photograph to be used on the club’s social media channels. I give permission for video of my child to be used on the association’s website. I give permission for video of my child to be used on the association’s social media channels I confirm that I have read, or been made aware of, how these images or videos will be stored within the organisation.

Signature

Today’s date

Print name

Connecting our Youth with the Rightly Guided Scholars.