PARENT/GUARDIANName First Last Number of Children to Register(Required)One Child2 Children3 Children4 Children5 ChildrenDetail for ChildrenName GenderMaleFemaleAge121314151617Name GenderMaleFemaleAge121314151617Name GenderMaleFemaleAge121314151617Name GenderMaleFemaleAge121314151617Name GenderMaleFemaleAge121314151617Total Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Parental Consent Summer Camp(Required) I agree to Parental Consent Summer Camp.Parental Consent: As the parent / primary caregiver/ legal guardian of the child named above, I give consent for my child/children to participate in the following activities: 1. Summer Camp 2023 includes activities not limited to youth discussions, career development and much more. 2. indoor sporting activities including, table football, educational board games, boxing, summer camp debate challenge and being part of a team. I/We consent to the following statements: • I/We understand that whilst involved in the activities outlined above, my child will be under the care of the Camp Manager, supervisor and camp volunteers approved by Power House Community Network (“PHCN”). PHCN cannot be held responsible for any loss, damage or injury suffered by my child. Any injuries will be treated accordingly by the first aider and noted in the incident book. • Nothing shall exclude or restrict PHCN’s liability for death and/or personal injury caused by its, employees or agents, negligence or any fraud. • I/We agree not to hold PHCN responsible for the actions of my child or circumstances beyond the control of PHCN. • I/We are aware that I am responsible for my child being dropped off and collected from all activities and that PHCN is not responsible for the safety of my child outside of the event. • I/We understand that group photography/filming of the event may take place, and the resulting images may be used for commercial and/or promotional purposes. Individual images will only be used where specific written consent is provided. • In an emergency and/or if I cannot be contacted, I am willing for my child to receive necessary hospital or dental treatment including an anaesthetic. I agree to pay or reimburse PHCN for any associated costs that are not covered by the NHS or private medical insurance. • I/We agree to inform PHCN if my child/ren test positive for COVID-19. If my child/ren displays any symptoms of COVID-19, PHCN will provide a COVID-19 lateral flow test that my child/ren will self-adminster. If the results are positive, PHCN will immediately notify me and my child/ren will be collected. Pending the time of collection, I am aware that my child will be isolated. • I/We give consent for my child to take part in the Debate competition at Summer Camp 2023 should they wish to do so. Yes No By signing/typing my name above, I/We acknowledge that I have read the Code of conduct and agree to all the waivers, consents and agreements above. Date: Sign: Print name: Data protection: PHCN will keep your details and your child’s details as per our Privacy Policy (PHCN.org.uk/privacy) and GDPR regulations, to record your consent to the event explicitly referred to in this Form. Terms and Conditions I agree to the above Terms and Conditions