*1.Please fill out the child/young person’s details and indicate if your child/young person requires a parent/carer with them to provide 1-2-1 support (volunteers cannot provide this) by placing a tick beside their name.

1-2-1 can be provided at sessions for young people if pre-arranged and paid through self-funded or direct payment.(Required.)

Child/ Childrens name(s)

Does your child/ children require 1-2-1 support Yes/No

2.What is your Childs date of birth

*3.Please tick to confirm you have read and understood the group’s policies. These include but are not limited to the group rules, child protection, data protection and zero tolerance policies. (Available both online or in paper at the meet-ups)(Required.)

i Confirm that i have read and understood All About Us ASD Teens groups policies

*4.Contact Details
(These will be added to our database and used to keep you informed of group activities)(Required.)

Name

Address

City/Town

Postal Code

Email Address

Phone Number

*5.Child(ren) photo/video consent
We would be grateful if you could fill this form in to give us permission to take pictures and/or videos of your child(ren) and to use these in our printed magazine and online publicity, thank you.(Required.)

I / We give / do give permission for All About Us – ASD Teens to take photographs and or videos of my / our child(ren) named below:

I / We give / do not give permission for All About Us – ASD Teens to take photographs and or videos of my / our child(ren) named below:

Enter Child(rens) Name(s)

*6.All About Us – ASD Teens

Accident Form

We would be grateful if you could read this form carefully, sign it and return it to us.

1) I acknowledge that All About Us – ASD Teens provides recreational services ONLY, it does not provide child care services, and activities should not be used for such purposes.

2) I understand that there may be occasion that activities will be off-site and that this Waiver applies to all field trips, excursions, and any and all other off-site activities, regardless of where these programs or activities take place.

3) I agree that participation in any activity affiliated with the group is an acknowledgement that I have inspected the premises, facilities, equipment and that I find them to be safe for my child(ren)s observation, use, and participation.

4) For myself and anyone who claims on my behalf, I forever release and promise not to sue All About Us – ASD Teens, its Trustees, volunteers, and/or any other person or company in any way associated with the group, to the maximum extent allowed by law, from any and all liability, claims, demands, damages, or any other legal responsibilities in any way related to the group or its facilities or participation in any of the programs, events, or activities. This release includes without limitation any and all claims, foreseeable and unforeseeable, relating to physical or other injury, death, or damage to property and any and all claims relating to negligence or negligent instruction, hiring, supervision, inspection, or maintenance.

5) I forever assume full responsibility for any and all risk, known and unknown, of bodily injury, death, or property and other damage to my child(ren) both foreseeable or unforeseeable to the maximum extent allowed by law, while in, about or upon the premises of the group, while using the premises or any group facilities or group equipment, or while participating in any activity affiliated with the group, whether or not the injury occurs on the group's premises. I understand the risks inherent in the activities that the group carries out and assume all such risks, as well as all non-inherent risks.

I intend that this Waiver be as broad and inclusive as permitted by law and that, if any portion of this Waiver should be deemed invalid, the remainder will continue in full legal force and effect. I also intend that this Waiver will remain in full legal force and effect forever, regardless of whether or not my child(rens) registration has expired.

I have read, understand, and voluntarily sign the All About Us –ASD Teens Disclaimer, Assumption of Risk, and Waiver form. I further agree that no oral representations, statements, or inducements apart from the foregoing Waiver have been made. By signing this Waiver, I have agreed to all of the Waiver's terms and conditions.(Required.)

Child(rens) DOB

Signed by parents/Guardians

*7.Medical Consent Form(Required.)

In case of emergency All About Us – ASD Teens has got my consent to authorise medical care for my child(ren) listed below

In case of emergency All About Us – ASD Teens has not got my consent to authorise medical care for my child(ren) listed below

*8.Medical Details(Required.)

Our family doctor is

Address

Phone Number

Medication and Allergies (List for each young person)

9.Alternative contact Details if Parent/ Guardian cannot be reached (in order of preference)

First Contacts Name

Phone Number

Second Contacts Name

Phone Number

Third Contacts Name

Phone Number

*10.Child or young person consent form

I agree to (please tick):(Required.)

taking part in the activities at All About Us – ASD Teens

talk to Christina or Shannon O’Neill if I am not comfortable at any time during the activity so they can help me or arrange for me to do something else

All About Us – ASD Teens keeping a record of this form so they have the information they need to keep me safe during the activity

receiving any emergency medical treatment that I may need

being filmed or photographed during the activity. I understand that the photographs or film might be used to tell other people about what All About Us – ASD Teens does.
Note: If I don’t agree to this, All About Us – ASD Teens will not use any images of me.

*11.I understand that enjoying the activity and being safe means I need to follow the behaviour code and safety rules.(Required.)

Childs Name

*12.Property Consent

permission to bring their own electronics and property (phone/tablet etc.) To All About Us meetups and activities.(Required.)

I do not give my son/daughter permission to bring their own electronics and property (phone/tablet etc.) To All About Us meetups and activities.

I do give my son/daughter permission to bring their own electronics and property (phone/tablet etc.) To All About Us meetups and activities.

I am aware that All About Us is not responsible for any loss or damage to the personal items.

*13.Walking Home Permission(Required.)

I/We do not give permission for my son/daughter to leave all about us without adult supervision for their journey home after the meet ups which they have attended.

I/We give permission for my son/daughter to leave all about us without adult supervision for their journey home after the meet ups which they have attended.

I/We never give consent for my son/daughter to walk home they will always be collected by an adult

14.Continued: Walking home Permission

I/We are fully aware that the group DOES NOT take responsibility for the safety of my son/daughter when they have left the premises for their journey home.