General wellbeing programme Booking form

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

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

(if under 16)

MEDICAL DETAILS

Please note that staff only have basic first aid training, so it is the responsibility of the participant/parent/guardian to arrange any medical safeguarding measures required. Regrettably, the venue is not suitable for wheelchair users.

PROGRAMME - Please check which programmes are available on our website before completing this form, checking the date and time of the programme you wish to book, as we often have more than one programme running a day.

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 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 give 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 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 leader, are solely for the purpose of aiding you in improving or enhancing your mental wellbeing. You hereby give such consent to your leader to assist you in achieving such aims. Where we think it is in the interest of your wellbeing, 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 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 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 have Covid-19 symptoms (high temperature, a new continuous cough, or loss or change to your sense of smell or taste), please DO 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 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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