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Creative sessions and hot lunches at St Anne's this winter holidays
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Name
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Nickname
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Pronouns
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Date of birth
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Address
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Postcode
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Phone number
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Email address
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Emergency contact details (name, phone number, relationship to young person)
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Dates you'd like to attend sessions? All sessions run from 10.30am - 2.30pm. You can tick multiple dates.
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Are you in receipt of free school meals?
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Do you have any dietary requirements or allergies?
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What's your favourite thing to eat?
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What's your least favourite thing to eat?
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Do you like the sound of any of the following menus (you can tick more than one!):
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Do you have any access requirements or anything else you want to tell us?
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Confirmation
I also agree to the following Parent / Guardian Consent Statements
1) If it becomes necessary for the above-named young person to received medical treatment and I cannot be contacted to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the leader in charge to sign any document required by the health authorities.
2) If the named-above young person is deemed unfit to participate in any part of the programme, or leaves an activity without permission, I agree to make immediate arrangements for them to leave the project site until agreed with the staff that they are fit to return.
3) I give permission for photographs, videos and other recorded information of my child to be used in publicity and evaluation materials.
4) I confirm that the information on this form is correct and I agree that the information can be used in accordance with Bricks privacy statement (details above). I will inform Bricks of any changes to these details.
1) If it becomes necessary for the above-named young person to received medical treatment and I cannot be contacted to authorise this, I hereby give my general consent to any necessary medical treatment and authorise the leader in charge to sign any document required by the health authorities.
2) If the named-above young person is deemed unfit to participate in any part of the programme, or leaves an activity without permission, I agree to make immediate arrangements for them to leave the project site until agreed with the staff that they are fit to return.
3) I give permission for photographs, videos and other recorded information of my child to be used in publicity and evaluation materials.
4) I confirm that the information on this form is correct and I agree that the information can be used in accordance with Bricks privacy statement (details above). I will inform Bricks of any changes to these details.
No responses yet for this question.
Thank you for taking the time to fill in our form! We are looking forward to getting creative with you this winter.
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