Volunteer parental consent form

Volunteers - Rhiannon Route

This form must be completed by the parent or guardian of any Under-18 left in sole supervision of a staff or volunteer of Somerset Wildlife Trust.

To find out how we use and protect your personal data and your rights, please see our Privacy Policy: http://www.somersetwildlife.org/Privacy_Policy.html. We promise to never sell your details to other organisations. You can change your communication preferences at any time’ by emailing us at volunteering@somersetwildlife.org or by calling us on 01823 652400

Your child's details

First name

Last name

School

Address

Country

Date of birth

Emergency contact details

Emergency contact must be a parent or guardian.

Emergency contact 1

Name

Relationship to child

Home phone number

Work phone number

Mobile number

Emergency contact 2

Name

Relationship to child

Home phone number

Work phone number

Mobile number

Medical information

Does your child have any illnesses, disabilities or allergies that may affect him/her during the placement?

Yes

Does your child require the routine use of any medication?

Yes

Please provide details for the above

Please note if a child needs to take medication whilst on SWT activity this will need to be self-administered.

Name of child's GP

Surgery name and address

Surgery phone number

Date of last anti-tetanus injection

Please give other relevant details of additional needs

Agreement

I agree to let my child participate in the SWT activities led by staff or volunteers. I understand that occasionally a planned task may be changed at short notice due to the weather, staff sickness or other unforeseen circumstances.

Yes, I agree

Signed- Full name

Date