Y-Wise Consent Form

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?

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

Y-Wise Consent Form

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