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DofE Silver Consent Form 2023

DofE Silver Consent Form 2023 (Year 10 students) https://www.dofe.org/do/basicinformation/

First Name*
Surname*
Initials*
Date of Birth*
Gender*
Address*
Post Code*
Home Telephone Number*
Emergency Telephone Number*
Please state any allergies e.g. aspirin, antibiotics, foods etc.*
Please explain any illness (including asthma), condition or disability*
Explain any contact with any contagious diseases in the past month*
Explain any injuries during the past month*
Please state any medication that has currently been prescribed or being used*
Is your child immunised against Tetanus? (please state the approximate date)*
Doctor's Name*
Doctor's address*
Doctor's telephone number*
I confirm my son/daughter is capable of taking part in all of the activities as described*
I confirm my child is willing to participate in the DofE Silver award level scheme*
In the event of illness or injury I agree to authorise members of staff during the course to consent on my behalf for an anaesthetic to be administered or any other urgent medical treatment upon the advice of a qualified medical practitioner*
I give permission for my child to be photographed yes/no*
I give permission for my child's photo to be placed across Knole Academy's social media channels*
Name of parent/guardian*
Signature of parent/guardian*
Date:*
Volunteering activity - What are they planning on doing? Where it is occurring? Who will the assessor be (not related to child)? and either an email or phone number for the assessor*
Physical activity - What are they planning on doing? Where it is occurring? Who will the assessor be (not related to child)? and either an email or phone number for the assessor*
Skills activity - What are they planning on doing? Where it is occurring? Who will the assessor be (not related to child)? and either an email or phone number for the assessor*

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DofE Silver Consent Form 2023

DofE Silver Consent Form 2023 (Year 10 students) https://www.dofe.org/do/basicinformation/

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