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Please read! Important information.

Please take a moment to complete this important form with required medical information and parents/guardians consent.

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Medical & Parent/Guardian Consent Form

It is vital that you correctly complete this form.

Medical Information for Child

Name of Your Child

How old is your child*

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• Click to select
• 7 years
• 8 years
• 9 years
• 10 years
• 11 years
• 12 years

Name of School*

Select Year*

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• Click to select
• Year 4 - 6 (Only Osidge & Potten End)
• Year 3 - 6 (Only Thomas Coram)

Does your child have any allergies?*

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• Click to select
• Yes
• No

If yes, please provide essential details.*

Is your child on any medication?*

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• Click to select
• Yes
• No

If yes, please provide essential details.*

Does your child have any illnesses that we should know about?*

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• Click to select
• Yes
• No

If yes, please provide essential details.*

Is there any other information that you would like to share about your child? Please enter below.

Select only if you registered another child

Child 2

Register Child 2

First Name*

How old is your child*

Click to select

• Click to select
• 7 years
• 8 years
• 9 years
• 10 years
• 11 years
• 12 years

Name of School*

Select Year*

Click to select

• Click to select
• Year 4 - 6 (Only Osidge & Potten End)
• Year 3 - 6 (Only Thomas Coram)

Does your child have any allergies?*

Click to select

• Click to select
• Yes
• No

If yes, please provide essential details.*

Is your child on any medication?*

Click to select

• Click to select
• Yes
• No

If yes, please provide essential details.*

Does your child have any illnesses that we should know about?*

Click to select

• Click to select
• Yes
• No

If yes, please provide essential details.*

Is there any other information that you would like to share about your child? Please enter below.

Parent/Guardian Consent

Can your child leave the programme venue, to attend our supervised outdoor activities?*

Yes

No

(Over 12 years only) Can your child leave to go home at the end of the day alone? *

Yes

No

Is your child allowed to receive sweets, biscuits, or crisps as prize rewards?*

Yes

No

Photos or film footage of your child taken during the programme maybe used on our website or promotional material. Please indicate if you consent to this.

Yes

No

I attest that all the information given above are correct and up to date.*

Yes

No

Parent/Guardian, please enter full name below to sign.*

 

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