(If the name you are known by is the same as your given name then please leave this blank)
Please tell us what year the participant is currently studying at High School.
Does the participant have any medical conditions requiring special medical treatment including medication?
Does the participant have any additional support requirements?
Please indicate which workshop activities you might be interested in taking part in. This is for information purposes only and sign ups for individual workshops will take place on the day of the session.
I agree to the participant receiving emergency dental, medical or surgical treatment, including a blood transfusion and anaesthetic, as considered necessary by the medical authorities present. I understand reasonable attempts will be made to contact parents/carers before administering treatment. Any parents/carers with objections to the administration of blood products should contact us for a KICbld Form.
During the course of this project young people may be photographed and/or filmed. Images and video created during the course of the project may be shared via our own and associated partner’s social media channels, websites or for publicity purposes. Please indicate whether or not you agree to images and/or video of the participant being used in this way.
I acknowledge the need for responsible behaviour on their part and accept that leaders will make decisions based on the safety of the group as a whole. They have the right to exclude young people if their behaviour becomes unacceptable.
I declare the information I have provided is correct. I acknowledge I should inform you as soon as possible about any changes to the information above which may affect their participation.
Please provide the name of signatory. (Parent/legal guardians must provide signature for all participants aged under 16 years old.)