Consent Form

Consent Form

Thank you for completing the medical and emergency contact information form below. Please complete one form per child accessing the project.

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Young Carer Details

Young carer name

GP Details

GP address

Medical Consent

Does your child suffer from?

Media Consent

I consent to my child being in photos / videos that maybe be published on our website or on our social media platforms to raise the profile of young carers and the services we offer.

Emergency Contact Information

Second emergency contact
Second emergency contact address details
Third emergency contact
Third emergency contact address details