SHOUT Consent Form

 
By completing this form, you are consenting to your child's personal details being used to produce a SHOUT card.

INFORMATION USE:
Where consent is given, the personal details will be held by East Ayrshire Council through the Vibrant Communities for the purpose of preparing, issuing and replacing (if necessary) the East Ayrshire SHOUT Card.  Details will be held for no more than 3 years after the expiry date featured on your child's card for monitoring purposes only and all the information given will be held in the strictest of confidence and will not be passed onto any other organisations.
 

1. Child's Forename *

 

2. Child's Surname *

 

3. Gender *

 

4. Flat letter / house name

 

5. House number

 

6. Street name *

 

7. Town *

 

8. Postcode *

 

9. Date of birth *

   DD/MM/YYYY 
 
 

10. Parent/Guardian telephone no. *

 

11. Parent/Guardian mobile no. (if applicable)

 

12. e-mail address

 

13. Name of Primary School (or select pre-school) *

 

14. Primary stage
(Please note this should be the child's present primary stage or the year just completed. Do not select the stage the child will start after the summer.) *

 

15. How did you find out about the SHOUT card? (Please tick all that apply)