Text Box: This form is for you to give permission for your child to attend the young carers group and to allow Crossroads Young Carers project to take your child on outings and weekend residentials. (You will be notified of all outings etc & further details will be sent nearer the time)   CONSENT FORM FOR YOUNG CARERS PROJECT   Name of Child: ………………………………………………....................…………………………………….………… Date of Birth: ……………………………………………......................…………………………………………………. Parent/Guardian Name: …………………………………….......................………………………………………………  Address: ……………………………………………......................……………………………………………………… Telephone Number: ……………………………….......................……………………………………………………….  Emergency Number: …………………………………………......................………………………………………….....  National Health Number (If Known): ………………….......................…………………………………………………  Dietary Requirement: …………………………………….................……………………………………………………  Any Medication presently taken: ……………………………...................…………………………………………….  Any Known Allergies: ………………………………………………..............………………………………………….  Any other helpful information (e.g. does your child experience diabetes, asthma or epilepsy?): …………………………………………………………………………………………………............................................ Name & address of Doctor: ………………………………………………………………………................................... ……………………………………………………………………………………………………......................................... Telephone number of Doctor: …………………………………………………………………………….......................   Permission   If you disagree with anything below, please cross it out. Then sign the form.   Crossroads Young Carers project can: *        Act in my place (this is called being “in loco parentis” where necessary during the project meetings / outings / residentials (e.g. by consenting to medical attention if my child has injured themselves), which may include a helper consenting to the use of anaesthetics. *        Give my child their regular medicines as listed above *        Give my child PARACETAMOL or IBUPROFEN for mild pain *        Give my child travel sickness pills e.g. Joyrides or Kwells *        Allow my child to take part in activities with the group. (Outings and residential activity information will be sent to you nearer the time) *        Use appropriate photographs of my child in promotional material such as the organisation’s Annual Report. *        If necessary, discuss basic relevant information with other professionals/the person who made the referral.  (E.g. If the Young Carers Project is asked if your child attends a group we are able to give the answer.)    I have read this form and have given as much information as I can to the young carers project. Should the information change I will contact the young carers project with the relevant information.   Signed ……………………………………………………… Date …………………………………   Print Name  ………………………………………………………………………………………..…      We must have one consent form for each child