EV2 CONSENT FORM (for Educational Visits) - Leeds City College

4. For Swimming Activities or Activities Where Being Able To Swim Is EssentialIs the participant:(please delete as appropriate)- Able to swim 2 lengths of a 25m pool (50 metres)? YES / NO- Water confident in a pool? YES / NO- Confident in the sea or in open inland water? YES / NO- Safety conscious in water? YES / NO- In good health and I consider him/her fit to participate in water activities? YES / NONB: Consent does not remove the need for Group Leaders to ascertain for themselves the level of the participant’sswimming ability.5. Emergency Contact Information(i.e. contact number, relationship e.g. mother, spouse etc)Contact 1 (Please indicate whether work or home number)Name:Relationship to participant:Daytime Contact Number: Evening Contact Number :Contact 2 (Please indicate whether work or home number)Name:Relationship to participant:Daytime Contact Number: Evening Contact Number :6. DeclarationParticipantI agree to behave in a safe and appropriate manner at all times.Name: Signature: Date:(please print)Parent / Guardian / CarerI have read the information provided, understand the associated risks, and agree to the participantvia the method of transport indicated, and participating in the activities described for this visit.travellingI also agree to the participant receiving medication or emergency medical treatment, including anaesthetic or bloodtransfusion, as considered necessary by the medical authorities present.Name: Signature: Date:(please print)Relationship to participant, if not a MOS / Volunteer:(If not 18, or designated independent, then this form must be counter signed by a parent / carer)A full risk assessment for this activity/visit has been carried out and is available upon requestThe processing of this data is in compliance with the 1998 Data Protection Act.This form must be taken by the Group Leader on the activity, and a copy must be retained by the Collegeemergency contact person