12TH WALLASEY SCOUT GROUP

Please tick which section your child is with:

Beaver Scouts
Cub Scouts
Scouts
Explorer Scout - Young Leader

Enter the name of the young member below:

Permission & Consent

Please tick below to confirm:

I agree to my child taking part in this activity and I give my permission for them to do so.
I would not like my child to take part in this activity (please go straigh to submit if you have ticked this option).

If you agree to your child taking part in this activity, please complete the rest of the form below, thank you.

Please insert your full name:

Please enter your valid email address below:

Health Information

Does your child have any known emotional or behavioural problems?

No
Yes

If Yes to the above question, please provide brief details so we try to tailor the workshop to help.

Please tick any and all of the following health conditions if they apply to your child:

Asthma
My child takes medication for Asthma and will have this with them on the day!
Epilepsy
My child takes medication for Epilepsy and will have this with them on the day!
Allergies / Anaphylaxis
My child takes medication for Allergies and will have this with them on the day!

Activities Consent

Relax Kids classes include movement, stretches, visualisation and breathing exercises. Do you consent to your child being involved in these activities?

Yes
No

Relax Kids classes also include the option for children to engage in self or peer to peer massage (fully clothed). These are calming exercises used to promote positive touch and encourage respect, communication & empathy among peers. Children become aware of their own bodies and learn to respect others. Do you consent to your child being involved in these activities?

Yes
No

Additional Information

Please tick the following to indicate you have read, understand and agree with the statements made:

I understand this activity will take place in the presence of Section Leaders and in full accordance with the Scout Association Policy Organisation Rules.
I understand Relax Kids Wirral has been invited to deliver an activity to support the Scout Group's A Million Hands activities and all necessary assessments have been undertaken by the Group Scout Leader, specifically in relation to Safeguarding and Health & Safety.
I have discussed this activity with my child and they are happy to take part in the Relex Kids Workshop
In understand this form will be shared with the Relax Kids WIrral counsellor Leigh-Anne for use only in relation to this Workshop

Please Sign Electronically (write your name in full):