CORNWALL STARS CHEERLEADING & TRAMPOLINING CLUB Child Consent Form
Participant’s name: ………………………………………… Date of Birth ………………………… MEDICAL INFORMATION ABOUT YOUR CHILD
Does your child suffer from a medical condition/allergies? Yes
If yes please give brief details (e.g. Asthma – takes ventolin, Diabetes – takes insulin) ……………………………………………………………………………………………………………
………………………………………………………………………………………………………….
Is your child receiving any medical treatment at present? Yes
If yes, give details of illness/disability and treatment
………………………………………………………………………………………………………….
Name and Address of own Doctor …………………………………………………………………
………………………………………………………………………………………………………….
Doctor’s Telephone Number ……………………………………… Does your child have any special dietary needs? ………………………………………………. Additional information from Parent/Carer if required ……………………………………………. …………………………………………………………………………………………………………. PARENTAL CONSENT
1. I have read the information provided and agree to my son/daughter taking part in the
2. I acknowledge the need for him/her to behave responsibly at all times. 3. I understand that the staff responsible for the activities will take all reasonable care of
4. I consent to my child travelling in a motor vehicle driven by a member of staff or other
adult in the event of an emergency and in accordance with associated guidance.
5. Please note that if your child has an accident or suffers loss or damage to his/her
personal effects or money which is not as a result of lack of care on the part of the club, the club will not be able to pay any damages or meet any expenses arising.
DECLARATION
I consent to any emergency medical treatment required by my child during this event. I will inform the club of any changes of circumstances.
Parent/Carer Signature: …………………………………………………………………………………. Print Name ………………………………………………………
Address ……………………………………………………………………………………………………. Home Telephone No ……………………………………………………………………………………. Emergency Telephone No (if different) …………………………………………………………………
The Use of Images of Children Parent/Carer Consent Form
Name of Child: …………………………………….
Please delete as appropriate 1. I agree that the Cornwall Stars can take photographs of my child Yes/No
which may be used in literature (e.g. newsletters and other promotional material etc.) 2. I agree that the Cornwall Stars can use images of my child on its web Yes /No site. (Please note the web site can be viewed across the world). 3. I agree that the Cornwall Stars can take photographs of my child for Yes/No
the club’s own records, archives and future interest (e.g. photographs of session).
4. I agree that my child can appear in collections of photographs
Yes/No
stored on CD ROMs which the Cornwall Stars may make of events and which it may sell to parents of children who have attended the sessions to raise funds for the benefit of the club. 5. I am happy for the press to take and use images of my child.
Yes/No
6. The Cornwall Stars may give the press the first name only / first and Yes/No surname (delete as appropriate) of my child for publishing with the child’s photograph in a newspaper or for captioning on television.
I have read and understood the conditions of consent. Signature of parent/carer: ……………………………………………………………. Date: ………………………… Name (in block capitals): ……………………………………………………………………
COMMENTARY: THE PAIN OF RISING DRUG COSTS UUP President William E. Scheuerman Professor of Political Science, SUNY Oswego January 2006 This commentary was recorded in January 2006 on WAMC-Northeast Public Radio. COMMENTARY: THE PAIN OF RISING DRUG COSTS There’s a health care crisis in the United States. Costs are sky- rocketing. Many Americans have no health care cove
Extended Abstracts – 21st Australian Clay Minerals Conference – Brisbane, August 2010 The effect of clay mineralogy on the transport of bromide and nalidixic acid in water- saturated soil columns K. Hanna1, E. Clervil1, 2, M. Usman1, E. Emmanuel2, C. Ruby1 1Laboratoire de Physique Chimie et Microbiologie pour l’Environnement, LCPME, UMR 7564 CNRS Université Henri Poincaré, 4