LLANFYLLIN

PUBLIC INSTITUTE

Cuepoint Activity Consent Form

Version 1.7 | Issued January 2026 | Review date January 2027

Sessions run Mondays, 5:00pm–8:00pm. Any changes will be communicated by email to parents/guardians.

Child Details

Full Name *

Date of Birth *

Home Address *

Parent / Guardian Details

Name *

Relationship to Child *

Telephone *

Email *

Emergency Contact (if different)

Name

Telephone

Medical, Allergy & Additional Needs Information

Details (including dietary requirements)

Collection and Leaving Arrangements *

Child permitted to leave unaccompanied Child must be collected by authorised adult

Photography and Video Consent *

Permission given Permission not given

Parents' WhatsApp Group – Communication Consent *

I consent to being added I do not consent

WhatsApp Group Code of Conduct

The group may be moderated and inappropriate content removed
Respect privacy: do not share phone numbers or screenshots outside the group
Not for complaints—contact organisers directly
Do not post photographs or videos of children
Do not share personal data about children or families
Administrative and operational communication only

Managed in line with ICO guidance on messaging apps.

Declaration & Signature

I confirm the information provided is accurate and consent to my child's participation. I understand safeguarding concerns may be shared with statutory agencies where necessary.

Type your name as signature *

By submitting this form, you are confirming your consent electronically.

Data Processing & Privacy Notice (UK GDPR)

Llanfyllin Public Institute is the Data Controller. Personal data is used solely for safe and effective delivery of Cuepoint activities. Data is stored securely and shared only where legally required.

Data Protection Contact: Treasurer@publicinstitute.co.uk

Safeguarding Statement

Llanfyllin Public Institute is committed to safeguarding and promoting the welfare of children.

Designated Safeguarding Officer: Andrew Griffin | 07927 071255 | andrewcgriffin65@gmail.com

All fields marked with * are required