Boxwave Parental Consent & Information Form Child's full name * First Name Last Name Email * Age * Date of birth * Home address * Parent/Guardian full name * First Name Last Name Relationship to child * Contact number * Secondary emergency contact (name, relationship, number) * Medical / Health Information Does your child have any medical conditions? * Yes No If yes please specify Any allergies? * Yes No If yes please specify Is your child currently taking any medication? * Yes No If yes please specify Travel & Participation Consent I give permission for my child to travel by minibus with Boxwave staff to and from Stamford Bridge, London, to take part in the John Terry & Boxwave Experience. I understand that: * • My child will be under the supervision of DBS-checked Boxwave staff. • Boxwave staff will contact me immediately in the event of an emergency or concern. • I am responsible for ensuring my child is dropped off and collected at the agreed location and time. I consent to my child attending and travelling under Boxwave’s supervision. Emergency Medical Consent In the unlikely event of a serious accident or illness, I authorise Boxwave staff to act in loco parentis and, if necessary, consent to emergency medical treatment for my child. * I consent to Boxwave acting in the best interests of my child in a medical emergency. Filming & Media Permission Footage and photos may be taken during the event for use on Boxwave’s social media channels and promotional materials. * Yes, I give permission for my child to appear in filming and media. Declaration By typing my full name below, I confirm that all details provided are accurate and I give full consent as described above. * Parent/Guardian full name: Date MM DD YYYY Thank you!
