Consent Form

The Louise Nicholas Trust is committed to ensuring that your rights, privacy, and wellbeing are respected. Please read the information below and confirm your consent

Please fill out the following form.

Purpose Of Consent

I understand that by giving consent I am:

a) Agreeing to participate in the services offered by The Louise Nicholas Trust

b) Informed of your right to access information collected about you, and to the correction of that information (if necessary)

c) Allowing The Louise Nicholas Trust to use my information for reporting and data collection purposes (written or verbal)

d) You agree to the following services provided by The Louise Nicholas Trust:

Please tick what best applies to you

Your Rights:

• You can withdraw your consent at anytime by contacting The Louise Nicholas Trust.

• You can choose your level of anonymity.

• Your full name will never be published or displayed without your permission.

• Your information will not be shared outside of The Louise Nicholas Trust without your consent.

Consent on behalf of another person

(To be completed if consent is given on behalf of a person under 18 years of age, or a person unable to consent due to disability or other impairments)

I confirm that I am the parent/guardian/legal representative of the person named below and have authority to give consent on their behalf.

Declaration

I have read and understood the information above. I consent to my participation and services provided by The Louise Nicholas Trust.