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Edventures Data and Medical Form 2018/19
Parent and Child Information
Personal Information
Child's Name *
Your answer
Date of Birth *
Your answer
Current School *
Your answer
Parental/Contact Information
Name of Mother/Guardian *
Your answer
Address *
Your answer
Home Telephone Number *
Your answer
Mobile Number *
Your answer
Email *
Your answer
Name of Father/Guardian *
Your answer
Address (if different from above)
Your answer
Home Telephone Number *
Your answer
Mobile Number *
Your answer
Email *
Your answer
Other Contact Information
Please provide details of any other parent, step-parent, grand-parent, family member or emergency contact
Contact Name
Your answer
Address
Your answer
Home Telephone Number
Your answer
Mobile Number
Your answer
Medical and Dietary Information
Name of Doctor *
Your answer
Doctor's Address *
Your answer
Doctor's Telephone Number *
Your answer
In event of an emergency *
Required
Collection Information
In the interest of safety, the staff need to know who will be collecting your child from Edventures. Please give below the names of any person who will regularly collect your child/ren from Edventures. (Name, relationship to child and usual day of collection)
Your answer
Collection Information Continued
If there is any person who is NOT to collect your child/ren please give details below or discuss in confidence with the Manager/Deputy.
Your answer
*
Required
Permission Information
Outings/Visits *
During your child's time in Edventures, we may occasionally decide to go for a walk around the local area or the local park etc.
Name of Sun Cream
Your answer
Sun Cream *
During the summer, we encourage the children to be outside as much as possible. On these occasions we require the children to wear both a hat and suncream. During hot/sunny weather, please ensure that you send your child into Edventures with both a sun hat and sun cream.
Photography *
During your child's time in Edventures, we may occasionally take photographs and videos of the children participating in various activities.
Required
Additional Information
Please provide us with any additional information
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