QFT LEARNING PARENTAL CONSENT FORM Name of child attending:____________________________________________________ Age (must be 12 yrs or above): ______________ Name of Parent/Guardian: ___________________________________________________ Emergency contact telephone number: ________________________________________ Event Nature of Activity: Date: Time: Duration: Venue: .Contact Person:
Takeover Film – Sci fi trailer making workshop Sat 1st Nov 2014 12:00-16:00 4 hrs QFT, Drama and Film Centre foyer, 20 University Square Marion Campbell, Education Officer, QFT Mobile: 07814 944020
Supervision/Welfare for participants for the event. As your child is under 18 a parent will need to sign this form, as he/she will participate in the Takeover Film sci fi trailer workshop. Supervision by Marion Campbell, QFT Education Officer and Sarah Lawrence, Film Tutor, Nerve Belfast. PLEASE COMPLETE: I give permission for the above named to attend the above filming, and for the finished trailer to be used for online promotional purposes by QFT/Takeover Film. YES/NO Photographs may be taken at the workshop. Theseimages will be used as a record of the event and to promote Takeover Film activity. The images may appear on the Takeover Film and QFT websites. I give permission for my son/daughter to be included in photos/film taken at the above event. YES/NO Does your child suffer from any illness or disability/allergies? If yes please give details Is your child receiving any medical treatment at present? Doctors Name Address of Surgery Date of anti-tetanus Hospital consultant (if applicable) Hospital Reg no. Signed: (Parent/Guardian)
Date:
The Safeguarding Children Policy is available on request or here: http://www.qub.ac.uk/directorates/HumanResources/PersonnelDepartment/RecruitmentandS election/SafeguardingChildrenandVulnerableGroupsPolicy/ For more details please contact Marion Campbell tel: 028 9097 1396. QFT, Centre for Drama and Film, 20 University Square, Belfast BT7. Website: www.queensfilmtheatre.com