Elysian Registration and Consent form CONSENT PACK part 1

Please complete this form before attending your first session. The information you provide helps us keep everyone safe and ensures we can contact the right people in an emergency.

Some participants may also be asked to complete additional Health & Medical Forms where appropriate.

Participant Name

First

Last

Participant Date of Birth

Participant Medical Information / Allergies

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

Emergency Contact Name

First

Last

Emergency Contact Phone

Transport Arrangements

Parent/Guardian drop-off and pick-up
Walking home (with permission)
Public transport
Other arranged transport

Authorised Collectors (names and relationship)

Health Information

Name and contact details of GP

Medical Conditions and Allergies

Medication (include dosage and timing)

Dietary Requirements

Support Needs (e.g., learning/behavioral/physical support)

Activities Registered For

Activities

Which Elysian site are you attending?

Please tell us about the participant's previous experience relevant to the activities they are attending (for example horse riding, animal care, farming, outdoor activities or similar).

Support & Participation

Can the participant safely take part in small group activities?

Yes
No
Sometimes

Can the participant follow staff instructions?

Yes
No
Sometimes

Is the participant comfortable around animals?

Yes
No
Sometimes

riding, Medical Phone

Does the participant require 1:1 support?

Yes
No

Is there anything else we should know to help support safe participation?

Declarations

I confirm the information provided is accurate.
I will notify Elysian if any information changes.
I understand activities involve outdoor environments, animals and uneven ground.
I understand additional medical information may be requested before participation.
I understand submitting this form does not guarantee a place.