Clubland Playscheme

Child's Name*

First Last

School*

To comply with the Data Protection Act 1998 and Ofsted regulations we require your permission for the following:

My child to receive emergency treatment if necessary*

Yes
No

My child to receive Infant Paracetamol and/or Piriton as and when deemed necessary*

Yes
No

My child to go on local outings within walking distance*

(to include visits to local parks & playgrounds)

Yes
No

My child to travel on a company vehicle, in accordance with Ofsted regulations*

Yes
No

My child to travel in a member of staff's car, in compliance with Ofsted regulations*

Yes
No

Sunscreen (provided by parent) to be applied as and when required by a member of staff*

Yes
No

Child can watch appropriate 'PG' certificated films*

Yes
No

I give permission for photographs or videos to be taken of my child (unidentified by their full name) to be diplayed...

At the club*

Yes
No

In publications for Clubland*

Yes
No

On the Clubland website*

Yes
No

Media: Use of Names*

Some Clubland activities attract elements of the media, do you consent to your child being photographed by local newspapers and other news media on the basis that their full names will be published along with their pictures?

Yes
No

Media: No use of Names*

Do you give permission for your child's image to appear on newspaper websites or television images? These publishers will be asked to avoid using your child's name, unless you give permission for their name to be disclosed.

Yes
No

Images for Surrey Early Years Quality Assurance scheme:*

I give permission for Clubland to use photographs to support our attainment of Surrey Early Years Quality Assurance Scheme and understand that Surrey Early Years moderators may view the photographs as part of the process.

Yes
No

I /we agree to abide by the Surrey Multi-agency information Sharing Protocol (MAISP) which is the over-arching protocol in a two-tier framework for information sharing in Surrey.*

Yes
No

More information at: http://surreyscb.procedures.org.uk/pkppq/policy-and-strategic-framework/information-sharing

Parent/Carer's Consent

I have read and understood Clubland Playscheme Ltd's permission form. My decision on whether to give consent will remain valid for the duration of my child's involvement in the organisation, unless I notify them in writing.

Parent / Carer's Name*

Prefix First Last

Email*

Date*

Permission Form

Permission Form

To comply with the Data Protection Act 1998 and Ofsted regulations we require your permission for the following:

I give permission for photographs or videos to be taken of my child (unidentified by their full name) to be diplayed...

Parent/Carer's Consent