Booking form

Please complete this booking form if you would like to join one of our programmes. If you are under 16, your parent or guardian will need to complete the form on your behalf. Fields with * must be completed please.

(if under 16)

MEDICAL DETAILS

PROGRAMME

Young Person programmeLGBTQ Young Person programme

BrightonHounslowRichmond

PHOTOGRAPHY OR FILMING

During some activities, there will be staff, authorised volunteers or partnership organisations taking photographs and/or filming parts of the session. Please indicate below if you consent to The Wild Mind Project taking photographs or films of participants and/or participants 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 giving consent or as a result of any publication of the materials.

I give permission for myself/my child's project/artwork to be photographed/filmed as per above YesNo

I giver permission for myself/my child 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:

• Participants using The Wild Mind Project’s services understand that these 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 therapist or leaders are not acting as medical professionals.
• You understand and agree that you are fully responsible for your own/your child’s (if the participant is under 16 years of age) wellbeing during your sessions, and subsequently, your choices and decisions.
• You also understand that all comments and ideas offered by a therapist/leader are solely for the purpose of aiding you in improving or enhancing your mental wellbeing. You hereby give such consent to your therapist/leader to assist you in achieving such aims. Where we think it is in the interest of your well-being, we may contact your 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’s 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 your own acts or omissions or acts and omissions of your Therapist/Leader as a result of any advice given otherwise resulting from the therapeutic/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 have Covid-19 symptoms (high temperature, a new continuous cough, or loss or change to your sense of smell or taste), or are classed as extremely vulnerable, or are in house isolation as someone else in your household is ill, please DO NOT ATTEND THE SESSIONS

If you have symptoms during or within 2 weeks following a session, please DO NOT attend further sessions and let us know immediately so that we can notify others.

PAYMENT

The programmes are grant-funded but sometimes we require a small contribution to cover all costs. If this is the case for the programme you are booking, please return to the programme website page and click the PAY NOW button to pay securely by PayPal. Thank you.

Please be aware that your place cannot be confirmed until the payment has been received.

SIGNING AND CONSENT

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 our 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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