Booking form - Learning disability programmes

PLEASE NOTE: These programmes are suitable for young people aged 16-25, with either a mild to moderate learning disability or mild to moderate autism.

Regrettably, we do not have the resources to support young people with very limited speech, who find it very difficult to learn new skills and who need support with daily activities such as dressing, washing, eating or keeping safe, regardless of a carer accompanying them. Failure to disclose a disability may result in us not being able to accept the applicant onto our programme. Please contact us if you are in any doubt.

Unfortunately, the venue is not suitable for wheelchair users.

A parent, guardian or carer will need to please complete the form on behalf of the participant. Fields with * must be completed.

PARTICIPANT'S DETAILS:

(please only enter an email that will be checked regularly for updates)

PARENT, GUARDIAN OR CARER'S DETAILS:

PARTICIPANTS MEDICAL DETAILS

PROGRAMME - Please check which programmes are available for young people with learning disabilities on our website, noting the date and the time of the programme (we often run more than one programme on the same day).

If it is necessary for a young person with a learning disability to have a carer in attendance, please let us know the carer's name.

PHOTOGRAPHY OR FILMING

During some activities, staff, authorised volunteers or partner organisations will take photographs and/or film parts of the session. Please indicate below if you consent to The Wild Mind Project taking photographs or films of participants and/or participant's project/artwork, and authorise us to use, reuse, copy, publish, display, exhibit, reproduce and distribute the materials in any educational or promotional materials or other forms of media without notifying you. Participants will not receive any payment from The Wild Mind Project for consent or as a result of any publication of the materials.

I give permission for the participant's project/artwork to be photographed/filmed as per above YesNo

I give permission for the participant to be photographed/filmed YesNo

LIABILITY WAIVER

This waiver of liability includes any risk of attending The Wild Mind Project programmes, events, workshops or other services provided by The Wild Mind Project. Please see the detail below:

• Parent/carers and participants understant that The Wild Mind Project’s services are not offered as a substitute for clinical mental health care or medical care, and are not intended to diagnose, treat or cure any mental health or medical conditions. You also understand that The Wild Mind Project leaders are not acting as medical professionals.
• You understand and agree that you are fully responsible for the participants wellbeing during the sessions, and subsequently, your choices and decisions.
• You also understand that all comments and ideas offered by a leader are solely for the purpose of aiding the participant in improving or enhancing their mental wellbeing. You hereby give such consent to the leader to assist the participant in achieving such aims. Where we think it is in the interest of the participant's well-being, we may contact their GP or authorised safeguarding body to share relevant information.
• You have read and understood the Privacy Policy and other documentation relating to confidentiality, adult safeguarding or child safeguarding.
• You hereby release, waive, acquit and forever discharge The Wild Mind Project CIC directors, staff, volunteers, consultants and partners from every claim, suit action, demand or right to compensation for damages claimed or that you may have arising out of the participants own acts or omissions or acts and omissions of your Leader as a result of any advice given otherwise resulting from the leader’s relationship contemplated by this agreement. You further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made.

COVID-19

If the participant has Covid-19 symptoms (high temperature, a new continuous cough, or loss or change to your sense of smell or taste), they should NOT ATTEND THE SESSION.

SIGNING AND CONSENT

By entering my name below, I hereby confirm that I have read, understood and agree to the contents of this form and The Wild Mind Project's safeguarding policy, privacy policy and terms & conditions. I understand and agree that no oral or written representations can or will alter the contents of this document.

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