y ffurflen i'w chadw gan y prosiect / Consent and medical form

advertisement
Canolfan Addysg Broffesiynol,
Campws Theatr Felinfach,
Dyffryn Aeron,
Llanbedr Pont Steffan
SA48 8AF
Tel: 01545 572352 / 01545 574931
Dear All
E-mail: dylan.davies@ceredigion.gov.uk
Ceredigion Youth Service are organising a Summer Skills Programme to up skill and
give young people an opportunity to attend taster courses in order to help them
experience a variety of work based workshops to assist the young people in deciding
their future career path. The Summer Skills Programme is aimed at 15-19 year olds
who are leaving or have left school and are unsure of what to do next with their
careers.
The Summer Skills Programme will be held over a two week period; 29th July – 2nd
August and the 5th August – 9th of August and all courses will be located in
Llandysul. A limited amount of transport will be provided to pick up participants on
each of the days from the following areas; Aberaeron Youth Centre, Lampeter
Secondary School, Tregaron Secondary School, Aberystwyth area and Cardigan
Youth Centre. Places will be allocated on a first come first serve basis.
Any young person interested in attending the Summer Skills Programme will need to
complete the slip below and return to me by the 5th of July. The workshops
comprise of carpentry, mechanics, child care residential, catering and hospitality,
cake decorating and hair dressing. In addition each participant will take part in a first
aid workshop, CV building workshop and an Interview and Communication skills
workshop. For all those who have successfully completed the two week programme
there will be an opportunity to attend an activity trip on the 9th of August. It is
anticipated that the workshops will commence at 11am and conclude at
approximately at 4.30pm.
There is no cost for attending the Summer Skills Programme and free lunch and
transport is provided. It is important therefore that once young people commit to the
programme that they attend as places are limited. If you have any queries then
please contact me by phone or email.
I look forward to hearing from you.
Kind Regards
Dylan Davies
Youth Engagement Coordinator
Summer School – Llandysul, 29th July – 9th August
Please fill in the slip below with the details of the young person who wishes to attend
the summer school:Name of Participant....................................................................
Address........................................................................................................................
.....................................................................................................
Post Code...............................
D.O.B.........................
Contact Number........................................................
Email.........................................................................................
Please circle where you would liked to be picked up from:Aberaeron Youth Centre
Lampeter Secondary School
Tregaron Secondary School
Aberystwyth area
Cardigan Youth Centre
Signed (Participant).................................................... Date...............................
Signed (Responsible Adult)..................................Print Name...................................
Relationship to participant............................................ Date.....................................
Please return this completed slip and the consent form to the following
address:Dylan Davies
Ceredigion Youth Service
Proffesional Education Centre
Felinfach Campus
Dyffryn Aeron
Lampeter
Ffurflen rhoi caniatâd a gwybodaeth feddygol Y person sydd â chyfrifoldeb rhiant i lenwi a llofnodi; y ffurflen i’w chadw gan y prosiect /
Consent and medical form - Person with parental responsibility to complete and sign; form to be
retained by organising project
Cyfeiriad a manylion y person ifanc / Young
person’s address & details
Cyfeiriad/Address
Enw/Name:
Dyddiad Geni/D.O.B:
Ffôn/Tel:
Cod post/Post Code
Enw Cyswllt gartref:
Cyswllt arall yn ystod yr ymweliad petai
argyfwng / Alternative contact during
this visit in case of emergency
Cyfeiriad/Address
Enw/Name:
Ffôn/Tel:
Cod post/Post Code
Rhowch fanylion ynghylch unrhyw gyflwr meddygol neu feddygyniaeth reolaidd y dylem wybod amdanynt /
Please give details of any medical conditions or regular medication that we need to know about
Please read and sign these two statements 1. Adult with parental responsibility I understand the information on this
form and on any attachments about this activity or residential, and consent to my child taking part. The information I have given on
this form is true to my knowledge. I will inform the Group Leader of any changes to my child’s health or fitness before departure. I
consent for my child to receive medical treatment in an emergency, including anaesthetics. I consent to visual images of my
child being used by the centre or group, which may include publicity in the press, other media and on the Web. I
have made sure that my child understands this information and that, for his/her safety, rules and instructions issued by staff must be
obeyed. I understand that if my child misbehaves, he or she may be returned home.
Date:
Signed (responsible adult)
2. Young person I agree that, for my own, the group’s and others’ safety, I will obey the rules and instructions of members of staff.
Signed (young person)
Date:
Download