Full Name: Home address: Postcode: Email: Date of birth (dd/mm/yy): Mobile number: Home number: Emergency contact name: Emergency contact number: Relationship to emergency contact: HEALTH INFORMATION: Relevant health issues and medication needs: Any known allergies: Specific advice to follow in case of an emergency: CONTACT DETAILS: Please only complete what you feel comfortable adding and that you feel is relevant. HEALTH AND CONSENT FORM ADDITIONAL INFORMATION DATA PROTECTION • Outside Lives Ltd (OL) is fully compliant with GDPR and is registered with the Information Commissioner ’ s Office (ICO) • Outside Lives Ltd will retain your information for a maximum period of two years after completion of your project / course. • All health forms are confidential and are kept in a secure storage box. Information on this form will only be shared with OL leaders, or other medical staff, in the event of an accident or emergency. E.g. learning or behaviour needs, access, support, dietary requirements, phobias First Aid being administered by qualified leaders & medical staff if needed I GIVE OUTSIDE LIVES PERMISSION TO: (Y/N ANSWER) Add me to their mailing list (no details provided to third parties) Take photos/films whilst I am involved in any workshops/courses* Use photos/films of me on OL website and social media platforms* Use photos/films of me in relevant OL publicity material and press releases* I CONSENT TO (Y/N ANSWER) Signed: Date: Outside Lives Ltd, Aberduna Hall, Maeshafn Road, Gwernymynydd, Mold CH7 5LE Please sign & return your completed form to outsidelivesltd@gmail.com *Parent/guardian consent required where child is under the age of 18.