Make a Smile Parental Permission Slip (Under 18s)

Background:

In essence, Make a Smile is a charity run by medical students that volunteers with a range of
organisations including hospitals such as the Heath, charities and disability schemes such as
Flamingo Chicks (teach ballet to children with disabilities). We attend events dressed as well
known children’s characters using costumes from a shared wardrobe. We are keen to
recruit some potential healthcare students to provide them with the opportunity to see and
experience a clinical environment and provide them with exposure to patients that will
benefit them in personal statements and (hopefully) upcoming interviews. There is of
course the bonus that they’ll be volunteering alongside a team of mostly medics so are
welcome to ask about the ins and outs of medicine.

Volunteers are trained prior to attending events, will never be left on their own with a child
and will always be with an experienced lead volunteer.

At events, volunteers will be expected to talk to and interact with a number of different
children including have pictures taken.

Permission:

I, ___________________________________________, being the parent or legal guardian of

____________________ (the “Minor”) hereby consent to and authorize the Minor to act as
a volunteer for Make a Smile. I acknowledge and agree that activities performed by the
Minor as a volunteer will be performed on a voluntary basis. I agree and understand that
the Minor must comply with the rules and regulations established by Make a Smile as
outlined in training, handbook and constitution.

I give permission for my son or daughter to take part in the volunteering above, including all
the activities involved. I have ascertained what activities are involved and this permission
extends to all activities involved in this event. I understand that although staff or leaders in
charge of the activities will take all reasonable care of the party members, they cannot
necessarily be held responsible for any loss, damage or injury my son or daughter suffers as
a result of their volunteering activity.

If your son or daughter becomes ill or has an accident requiring emergency hospital
treatment, please authorise the organisation named above, or someone acting on their
behalf, to sign any hospital written consent form needed if contact with you cannot be
obtained and the doctor has recommended that such treatment is in the child’s best
interests.
Photos:

Our organisation regularly takes photos and videos of volunteers for publicity. Before taking
images of children under the age of 18, we need their parents’ or carers’ permission.

May we use images of your son or daughter for publicity (including in brochures) or on our
website?

Yes/No

Medical:

Does your child suffer from any medical conditions that we should be made aware of? Eg.
Asthma, diabetes, depression, allergies etc.

Details:

Minor’s Name: ______________________________

Minor’s Date of Birth: _____________

Guardian’s Name: ______________________________

Relationship to Minor: __________________

Contact Number:__________________

Signature:

Date:________________