{"text":"LOTHTAN REGION LI OOUNCIL \nDEPARTMENT OF _50GIAL WORK \nCONSENT FORM - HOLIDAYS\/OUTDOOR PURSUITS \nCHILDREN IN CARE OF LOTHIAN REGIONAL COUNCIL \nChild's Full Name A\/\\)C\\L\/L.\ufb01 CK@QS)\/ Ehoai \u00ab o misdasanizd SEsRdi% \nChild\u00aes Present AdAress cee-.d \/\/ (:}}7df\u00a5ff\ufb02j ..4\u00a5?\u00a3\u00a5; .......... G iEasH \nI hereby give my consent to my ....... D\"\u2018:}\u2019UCJH\u2019(E ..(State relationship) \nparticipating in holidays and outings while he\/she remains in the care of the \nLothian Region, as may be approved by the Director of Social Work or his prescribed \nrepresentative. \nI understand that this consent applies within the period 1st January to \n31st December and will require to be renewed annually. In the event of my \nbeing unobtainable to renew the consent, I authorise the Director of Social Work . \nor his prescribed representative to sign on my behalf. \nI also give my consent to the administration of medical, surgical and \nanaesthetic treatment as may prove necessary. \nI give my comnsent to his[her i)articipation in the activities listed below \nplease tick (V) activities you consent to and cross (X) those you do not \nconsent to. \nSWIMMING ROCK CLIMBING RIDING . \nCANOEING HILL WAIKING CYCLING \nSATLING SKI-ING\/ FLYING \nTOBOGGANING \nWATER SPORTS SKATE BOARDING OTHERS \n(please specify) \n(Full Name) Signature ng\/\"au. \n(PARENT\/GUARDIAN) _ \n~1_,7\/ \n(Full Name) Signature ee..p%.. \nPP eeOOET TR OLOSOEGCEROENOOBTSDS \n(WITWESS) \nDate _...\u2019%g\u2019:\u2019..{. 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