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Consent Form for Archimake Workshops
If you have any queries, please email us; contactus@archimake.org
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Email *
Please take a couple of minutes to complete this form, which will ensure we are able to provide the best care for your child during our workshop session.
Parent's Name *
Tel no. (inc country code)
Child's Name *
Child's Age
Child's gender *
Address
Postcode
Ethnicity *
How did you hear about our workshop? *
Does your child have a disability or learning need? *
Parental / Guardian Consent & Declaration
I consent to the person named above participating in Archimake workshops as described above. I recognise that the accompanying staff will be responsible for their supervision and care as far as can be reasonably expected. I understand that they will not be constantly supervised. I acknowledge the need for responsible behaviour of the person named above and I believe that this can be expected of them.

I agree to inform Archimake in writing as soon as possible of any changes to medical circumstances of the person named above either prior to or during the programme. I will indemnify Archimake and its representatives, agents and employees from any responsibility given to them, in relation to acting in “loco-parentis” in the case of medical emergencies only.

I agree to indemnify Archimake its representatives, agents and employees, from all liabilities in relation to loss or damage suffered of caused by the person named about which result in negligence of Archimake or their representative or which result in the person named about failing to follow any reasonable instructions given to them.

I understand that photographs, audio and visual recordings of the participant engaged in Archimake activities may be used for promotional materials, such as websites, local and national media and I hereby give permission for this.

I understand that the information given may be kept on a computer database, which will only be accessed by Archimake. I confirm that I agree with the above declaration and the information on this form is complete and accurate to the best of my knowledge.

I consent to Archimake reproducing the artwork and photographic images of any artwork created during or as a result of an Archimake workshop. I consent to Archimake selling products which may use the aforementioned artwork to support their organisation and/or any bursaries they make available for charitable purposes. I understand Archimake may notify me of any sales made which have artwork created by my child/children/myself and it is up to me to keep Archimake updated with my correct contact details for this purpose.

Please note that Archimake reserves the right to refuse participation of any person if there are concerns raised about the response on this form, especially if it is due to misbehaviour of the young person.
Parent / Guardian name as signature:
Date
MM
/
DD
/
YYYY
Relationship to the child above *
A copy of your responses will be emailed to the address you provided.
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