Barnsley Metro Dome Swimming - Breeze

• Dear Parent
Barnsley Metro Dome
Swimming
Tuesday 10 th August 2010
11.15am – 3.30pm
• Your son/daughter has been invited to Barnsley Metro Dome Swimming
as part of Moortown out of schools activities programme.
• The cost of the trip is £2.00 which also covers travel by minibus
• Please bring swim wear and towel
• Please bring some money for lunch and snacks or a packed lunch
Travel Details:
Leaving from: Carr Manor School at 11.15 am
Returning to: Carr Manor School at 3.30 pm
Person responsible: Gary Ashcroft ( Senior Youth Worker Moortown)
Assistant: Carlee Sissons ( NEtWORKS Extended Services )
Emergency Tel. no. during visit 07891275651
Please note: If your son/daughter does not bring a signed consent form for
the activity they will NOT be allowed to come on the trip
Leeds Youth Service expect you to behave responsibly at all times

TRIPS CONTRACT FOR YOUNG PEOPLE
This contract is to be read, agreed and signed before any young person goes on a Youth Service
trip.
Mini Bus Travel
• Seat belts must be worn by all young people at all times.
• No rubbish to be thrown out of windows/doors.
• No verbal abuse to members of staff/public.
• No physical abuse to members of staff/other young people or the public.
• Swearing should be kept to a minimum and not used where possible and under no
circumstances be directed at staff
• Graffiti or any damage will result in a ban.
• Bin liners will be provided for rubbish. Staff and Young People are expected to use
them.
• Smoking is not permitted on the bus.
Cost of trips
• All trips cost money. This cost may be met by the young people or other funding
sources.
• All young people may be required to make a contribution.
General Behaviour
• Young people should be respectful to staff/public and each other.
• Any verbal and physical abuse could result in an exclusion from trips/activities.
• No person under 18 is permitted to smoke.
All parental consent forms must be completed by a parent/carer and have both a home and
emergency contact number. If the consent form are not returned you will not be allowed on
the trip.
Young people should be at the meeting point 15 minutes before the bus leaves.
Lateness may result in loosing your space.
Young people should return to the agreed meeting point at the stated time to ensure the trip
returns home on time. Any person returning late could jeopardise future outings.
I have read the above statement and agree to the terms and conditions.
Young Persons name……………………………………………....Signed……………………………….Date……………
Parent/Carer name…………………………………………………. Signed………………………………Date……………

PARENTAL CONSENT FOR A VISIT
(to be distributed with an information sheet(s) giving full details of the visit-Standard
information sheet)
1. Group: MT 41 Moortown Out of Schools Activities
Group Leader: Gary Ashcroft (Youth Worker)
2. Details of the visit to: Barnsley Metrodome
From: 10/8/10
Date/Time: 11.15 am To: : 3.30pm
I agree to:
(full name_
taking part in this visit and have read the information sheet(s) and agree to all activities
highlighted as part of the Trip, Visit or Residential.
I agree to:
‘s participation in the activities
described and I acknowledge the need for
to behave
responsibly and adhere to rules and regulations given by the group leaders.
3. Medical Information about the child
a) any conditions requiring medical treatment, including medication? YES / NO
If YES, please give details precise details:
b) please outline any special dietary requirements of your child and they type of
pain/relief medication your child may be given if necessary:
c) to the best of your knowledge, has your son/daughter been in contact with any
contagious or infectious diseases or suffered from anything in the last four weeks that
may be contagious or infectious?
YES / NO
If YES, please give brief details:
d) is your son/daughter allergic to any medication: YES / NO

If YES, please specify
e) when did your son/daughter last have a tetanus injection?
f) Young person’s date of birth
I will inform the Visit Leader/Senior Youth Officer as soon as possible of any changes
in the medical or other circumstances between now and the commencement of the
journey.
4. Swimming Consent Information (where applicable too the activity)
• Is your child able to swim 50 metres? YES/NO
• Is your child water confident in a pool? YES/NO
• Is your child confident in the sea or in open inland water? YES/NO
• Is your child safety conscious in water? YES/NO
I confirm that my child is in good health and I consider him/her fit to participate.
5. Declaration
I agree to my son/daughter receiving medication as instructed and any emergency dental
medial or surgical treatment, including anaesthetic or blood transfusion, as considered
necessary by the medical authorities present. I understand the extent and limitations of
the insurance cover provided.
I give consent to my son/daughter to be photographed as part of the programme, which
may be used in publicity material by the Youth Service.
Contact address and telephone numbers:
Work:
Home:
Home address:
Alternative emergency contact:
Name:
Telephone Number:
Address:
Name of family doctor:
Telephone Number:
Address:
Signed:
Date:
Full name of parent/guardian (capitals):
THIS FORM OR A COPY MUST BE TAKEN BY THE VISIT LEADER ON THE VISIT. A
COPY SHOULD BE RETAINED BY THE YOUTH SERVICE HOME BASED CONTACT.