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Complete a Project Consent Form

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Please complete this short form to provide Streetwise with the necessary consent to support your participation in any Streetwise activities:

Streetwise, part of Everyturn Mental Health, sometimes needs to share personal and sensitive information (e.g. name, date of birth, postcode) with other organisations who fund our work. We will only share this information with reputable organisations and when it is necessary to do so. I agree that Everyturn Mental Health can share relevant information about my child with reputable organisations as outlined above.

Details of young person

MM slash DD slash YYYY
Address*

Emergency Contact information

Medical information

As part of its work, Streetwise part of Everyturn Mental Health needs to collect and store sensitive personal information about service users. In order to do so, the law on data protection requires Streetwise to receive your explicit consent. Explicit Consent: I hereby consent to Everyturn Mental Health collecting and storing sensitive personal information about my dependant concerning the support, advice and / or counselling that they receive when accessing Streetwise’s services. The sensitive personal information that Everyturn Mental Health will collect and store will include; name, date of birth, address, residential, marital, ethnicity, medical details concerning my mental and physical health, and emotional wellbeing (where relevant). I understand that any sensitive personal information collected and stored by Everyturn Mental Health will: • Be retained for a minimum of eight (8) years after support / counselling has ceased • Be processed in accordance with the 2023 Privacy Notice, which I have read and understood. By signing this consent form, I confirm and understand that: • Confidentiality has been explained to me and I agree that my dependant’s sensitive personal information can be shared with others where another person or my dependant is at risk of significant harm • Sensitive personal information about my dependant can be collected and stored securely by Everyturn Mental Health, and I understand that such information can be seen by other workers within Streetwise part of Everyturn Mental Health • With my prior explicit consent, my dependant’s sensitive personal information can be shared with others outside of Everyturn Mental Health • I will contact Streetwise part of Everyturn Mental Health if my dependant cannot make an appointment that has been made for them • If referred by someone else, Streetwise part of Everyturn Mental Health may inform the referrer when counselling and / or support comes to an end • My dependants’ rights at Streetwise part of Everyturn Mental Health, including how to make a complaint and what rights they have in relation to their sensitive personal information, have been explained to me • I may withdraw my consent to Streetwise, part of Everyturn Mental Health, collecting and processing my dependant’s sensitive personal data at any time I have read and understood the above and give my explicit consent to Everyturn Mental Health collecting and storing mine and my (dependants) sensitive personal information in accordance with the 2023 Privacy Notice:*

As part of its work, Streetwise part of Everyturn Mental Health needs to collect and store sensitive personal information about service users. In order to do so, the law on data protection requires Streetwise to receive your explicit consent. Explicit Consent: I hereby consent to Everyturn Mental Health collecting and storing sensitive personal information about my dependant concerning the support, advice and / or counselling that they receive when accessing Streetwise’s services. The sensitive personal information that Everyturn Mental Health will collect and store will include; name, date of birth, address, residential, marital, ethnicity, medical details concerning my mental and physical health, and emotional wellbeing (where relevant). I understand that any sensitive personal information collected and stored by Everyturn Mental Health will: • Be retained for a minimum of eight (8) years after support / counselling has ceased • Be processed in accordance with the 2023 Privacy Notice, which I have read and understood. By signing this consent form, I confirm and understand that: • Confidentiality has been explained to me and I agree that my dependant’s sensitive personal information can be shared with others where another person or my dependant is at risk of significant harm • Sensitive personal information about my dependant can be collected and stored securely by Everyturn Mental Health, and I understand that such information can be seen by other workers within Streetwise part of Everyturn Mental Health • With my prior explicit consent, my dependant’s sensitive personal information can be shared with others outside of Everyturn Mental Health • I will contact Streetwise part of Everyturn Mental Health if my dependant cannot make an appointment that has been made for them • If referred by someone else, Streetwise part of Everyturn Mental Health may inform the referrer when counselling and / or support comes to an end • My dependants’ rights at Streetwise part of Everyturn Mental Health, including how to make a complaint and what rights they have in relation to their sensitive personal information, have been explained to me • I may withdraw my consent to Streetwise, part of Everyturn Mental Health, collecting and processing my dependant’s sensitive personal data at any time I have read and understood the above and give my explicit consent to Everyturn Mental Health collecting and storing mine and my (dependants) sensitive personal information in accordance with the 2023 Privacy Notice:

Streetwise part of Everyturn Mental Health sometimes needs to share personal and sensitive information (e.g. name, date of birth, postcode) with other organisations who fund our work. We will only share this information with reputable organisations and when it is necessary to do so. I agree that Everyutrn Mental Health, can share relevant information about my child with reputable organisations as outlined above.

Streetwise part of Everyturn Mental Health sometimes needs to share personal and sensitive information (e.g. name, date of birth, postcode) with other organisations who fund our work. We will only share this information with reputable organisations and when it is necessary to do so. I agree that Everyutrn Mental Health, can share relevant information about my child with reputable organisations as outlined above.

Please note that the project is Open Access which means that the young person is free to come and go during sessions.*
Please note that the project is Open Access which means that the young person is free to come and go during sessions.
We may take photos and use recording devices e.g. video cameras for use of display, publicity and project evaluation. These may be passed on to partner organisations during joint events etc. I agree for my child to be in photos and recorded material, to be used for displays, publicity and evaluation reasons. I also agree for photos and recorded material to be shared for publicity and promotional use.
We may take photos and use recording devices e.g. video cameras for use of display, publicity and project evaluation. These may be passed on to partner organisations during joint events etc. I agree for my child to be in photos and recorded material, to be used for displays, publicity and evaluation reasons. I also agree for photos and recorded material to be shared for publicity and promotional use.

Streetwise Characters - Streetwise North Newcastle Young Peoples Project

Unit 3 Blackfriars Court, Dispensary Lane, Newcastle upon Tyne, NE1 4XB
admin@streetwisenorth.org.uk
Registered Charity no: 1058360
Donations can be made via our
> www.justgiving.com/streetwise-ypp 
page or text

STREETWISE5 to 70085
one-off donation of £5.

STREETWISE10 to 70085
one-off donation of £10.

STREETWISE20 to 70085
one-off donation of £20.

Via PayPal:> https://paypal.me/StreetwiseNorth Thank you
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