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Y-Wise Consent Form
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SESSION VENUE
Child's Full Name
Age
NAME OF SCHOOL CHILD ATTENDS
Child's Email Address/School Email Address
Parent/Guardians name
Parent/Guardians email
Parent/Guardians contact number
HOW WILL YOUR CHILD GET HOME AFTER THE SESSIONS? COLLECTED BY PARENT/GUARDIAN
Walk Home Alone
Take Public Transport Alone
Collected by Parent/Gaurdian
PLEASE STATE NAME, RELATIONSHIP TO CHILD AND CONTACT NUMBER IF DIFFERENT FROM ABOVE
Does your child have an Allergy, Disability or Health Condition?
What is the childs Ethnicity/Cultural Background?
White
Black
Asian
Mixed
Other
WHITE ETHNICITY/CULTURAL BACKGROUND
English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy / Irish Traveller
Black ETHNICITY/CULTURAL BACKGROUND
African
Caribbean
Asian ETHNICITY/CULTURAL BACKGROUND
Indian
Pakistani
Bangladeshi
Chinese
Mixed ETHNICITY/CULTURAL BACKGROUND
White / Black Caribbean
White / Black African
White / Asian
Other ETHNICITY/CULTURAL BACKGROUND
Arab
Other
If other ethnicity please describe here
Give Consent to Media (Optional)
I am the parent/guardian of the above-named child and I give consent for Freedom Foundation to take photographs, film and record my child for promotional and research purposes.
Give Consent to Profile Creation
I am the parent/guardian of the above-named child and I consent to my child having a profile on the empower to learn hub via the Freedom Foundation website. This is a safe-space where children and young people can access inspirational content to motivate their minds and feel empowered. They will also have the opportunity to access additional support through their peers and our facilitators. For more information please visit:
www.freedomfoundationuk.org/about-e2l
Give Consent to Data Processing
I am the parent/guardian of the above-named child and I consent to Freedom Foundation processing this personal data to achieve their educational aims, including registration and ensuring the safety of my child at a Freedom Factory session.
Freedom Foundation's Privacy Policy is available at - www.freedomfoundation.org/privacy-policy
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