Kids Summer Camp Registration Form 2020

Step 1 of 3

  • Section 1: Parental Consent, Emergency Contacts and Risk Disclosure

    To be completed by parent/caregiver of child
  • Emergency Contact Details

    (Please provide at least 2 sets of contact details)
  • Eye Condition

    (please state):
  • Are you partially sighted?
  • Are you totally blind?
  • Do you wear glasses?
  • Contact lenses?
  • (e.g. getting around, steps, poor light conditions)
  • Do your child use a cane?
  • (e.g. email, braille, text, CD, large print etc)
  • (e.g. CCTV, laptop, magnifier, iPad)
  • If yes please specify
  • If yes please provide a copy or the name and contact details of the person or organisation who wrote this:
  • Special Notes:

  • (e.g. cultural practices; anxiety about heights/darkness/small spaces; swimming ability; distance capable of walking)
  • If yes names of staff involved:
  • Parental Consent

    To be read and signed by parent/caregiver of child participant I, the undersigned, have disclosed all necessary information to ensure my child’s safety and I agree to my child’s participation in this programme. I understand that places are limited and that due to the nature of some activities additional specific selection criteria may apply for health and safety reasons. I understand that my child may not therefore be selected for participation on this occasion. I agree that responsibility for safety is a 3 way partnership between participants, parents and staff running the event and that I will do my best to ensure that my child follows the instructions given by the Blind Foundation leader(s) Should my child need to be returned home from camp for any reason, I understand that I will be responsible for arranging their safe return home. I give my consent for my child to travel in vehicles driven by staff or volunteers, using approved seat belt restraints. I give my consent for my child being involved in any publicity, including photographs. The staff and volunteers will exercise all due care, but will be clear of all liability in the event of any injury, damage or loss my child may sustain to their person or property. The staff and volunteers of the BF will exercise their duty of care to protect children from unnecessary risk of harm. All possible care will be taken to ensure children’s wellbeing and safety. Staff will act without negligence. Any injuries or illness will in the first instance be attended by a staff member who is a first aider. I authorize that should qualified medical attention be required this will be secured at my expense and I will be promptly notified. I understand that the Blind Foundation does not accept responsibility for loss or damage to personal property and that it is my responsibility to check my own insurance policy. I have read the event information sheet and I understand that there may be risks associated with involvement in Blind Foundation events and that these risks cannot be completely eliminated. I understand that the Blind Foundation will identify any foreseeable risks or hazards and implement correct management procedures to eliminate, isolate or minimize those hazards. I understand my child will be involved in the development of safety procedures. I will do my best to ensure that my child follows these procedures. I know that I am able to ask any questions about the activities my child will be involved in, to gain a better understanding of the risks involved. I recognize that participation in such activities is voluntary and not mandatory through a ‘challenge by choice’* procedure. My child and I both understand that they may withdraw from an activity if they feel at risk. This must be done in consultation with the person in charge. (To be read and signed (electronic signature) by parent/caregiver of the child participant)