Child's Name
Date Of Birth
Gender
Ethnicity
Address
Postcode
Contact Number
E-mail Address
Does your child have a disability or condition we should know about?
Allergy Information / Dietary Requirements / Medical Information
GP Address
GP Contact Number
School Name
School Address
School Contact Number
Emergency Contact Number 1
Name & Relationship
Emergency Contact Number 2
I give permission for my child/guardian’s picture/recording to be used in publicity for Ginger Island Arts and Crafts. I allow this publicity to involve social media outlets including Facebook, Twitter and other forms which Ginger Island Arts and Crafts may use. YesNo
I give permission for my child/guardian’s to be face painted during their time at Ginger Island Arts and Crafts Half Term Club. YesNo
I agree with Ginger Island Arts and Crafts staff making the decision to seek medical advice/assistance for my child/guardian in my absence or if they feel it is required for the health and welfare of my child/guardian. YesNo
On submission of this form I state that I have read and understood the above statements and I am happy for my child/guardian to attend the sessions at Ginger Island Arts and Crafts Half Activity Club. * I agree
Date
