Lancashire Boys & Girls Clubs
'QUADSQUAD'
PARENTAL CONSENT FORM
PARENT/GUARDIAN:
TEL No:
ADDRESS:
Emergency Contact No. if different from that given:
CLUB/GROUP:
VENUE FOR ACTIVITY:
DATES OF ACTIVITY:
I hereby give permission for my son/daughter to take part in the 'QUADSQUAD' PROGRAMME and in case of illness or
accident requiring emergency hospital treatment, I authorise the leader-in-charge to consent to any necessary treatment.
If there are any matters regarding your son/daughter's health that we should be aware of including any medication being
taken please give details below:
When did your son/daughter last receive a Tetanus injection?
*Are you willing to consent to any photographs taken on the event to be used in the LACYP internal/external
YES/ NO
publications?
IMPORTANT
All Persons using vehicles as part of the 'QUADSQUAD' PROGRAMME do so at
their own risk.
Signature:
(Parent/Guardian)
Lancashire Boys & Girls Clubs
South Place, 1 Meeting House Lane, Lancaster, LA1 1TQ
Tel 01524 65106 Fax 01524 383525 e-mail: [email protected]
www.labgc.org.uk
CONTRACT OF INVOLVEMENT
The 'QUADSQUAD' Requests participants to:
1.
2.
3.
4.
5.
6.
7.
8.
9
10
Attend and participate fully in all module contents.
Complete modules in order.
Behave responsibly and to carry out instructions from the worker in charge.
Commit your full attention to the module work and riding.
Ride within your capabilities, and in a safe manner, paying due regard to other users.
Provide food and drink suitable to the weather conditions.
Wear appropriate clothing, footwear, suitable for cycling and the weather conditions
PLEASE NOTE: female participants are advised to wear a sensible supporting bra due
to the rough terrain riding
Keep to these conditions on the understanding that you can be suspended at any time.
Do your best to make this project work as well as possible.
The 'QUADSQUAD' Requests Clubs/Groups
To provide 2 responsible adults to be involved in the programme and who will
a.
b.
c.
d.
Ensure that the participating young people are aware of the purpose of the programme
and of their involvement.
Who will attend and participate in each session.
Ensure that your members/young people behave in an appropriate manner
which will be conducive to a positive learning experience.
Ensure that forms are completed and returned for stated deadlines.
The 'QUADSQUAD’ PROGRAMME WILL:
1.
2.
3.
Provide an activity inclusive of module work, instructions and riding skills
Strive to make activities and modules as interesting as possible.
Take all precautions to protect your safety.
I confirm that I have read and understood the conditions laid out on the contract of
involvement.
PARTICIPANT NAME:
(13yrs- 16yrs)
AGE:
Signature of participant:
(Please Print)
Date of Birth
Male / Female
Date:
Club/Group:
Worker in Charge:
(Please Print)
Worker in Charge
(Signature)
Lancashire Association of Clubs for Young People,
South Place, 1 Meeting House Lane, Lancaster LA1 1TQ
Tel 01524 65106 Fax 01524 383525 e-mail: [email protected]
www.la.org.uk