Creativity Camps Participant Sign-Up 10th & 11th April 2019

Ark T Creativity Camps is a Children In Need funded programme, offering an intensive creative camp for young people in the school holidays, in Oxford. It is designed to support young people aged 6-18 years to engage in the arts, in order to: Increase their confidence in learning, increase their emotional well-being, and increase their leadership skills.

Each day is from 9:30am - 2:30pm, and includes breakfast, snacks and lunch.

The form below must be completed for each young person hoping to attend, in full (by a parent of carer of the young person if they are under 16)

By signing below, you agree that the information above is correct to the best of your knowledge, and that you give permission for your young person to attend the camp, on the dates highlighted above.

Please email Lizzy McBain, Project Manager, Creativity Changes Lives Project, if anything changes: lizzy@ark-t.org

Please note that filling in this form does not guarantee your young person a place. We will email you to confirm by the end of 25th March.

All data inputted in to this form will be saved on a secure online storage system and / or on a secure external hard drive which will not be removed from the Ark-T site, for the duration of the young person's engagement with this group and/or until the period of the project funding is complete - 2021 (whichever is longer). No personal data will be shared with external partners, nor will it be stored on personal devices.

Creativity Camps are free to all children aged 6-18. We ask for a donation of £5-15 per day from those who can, to help cover materials and food costs.

Email address *
Young person's full name
Your answer
Which dates does your young person wish to attend?
Age at time of Creativity Camps
Your answer
Date of Birth
MM
/
DD
/
YYYY
Full Address
Your answer
Name of School if at school
Your answer
School Year
Your answer
Name of Doctor
Your answer
Full Address of Doctor
Your answer
Phone Number of Doctor
Your answer
Name of Parent / Carer if under 16
Your answer
Relationship to young person
Your answer
Full Address of Parent / Carer if under 16
Your answer
Phone number of Parent / Carer if under 16
Your answer
Emergency Contact name (if different from above)
Your answer
Relationship to young person
Your answer
Emergency Contact Phone Number
Your answer
Second Emergency Contact Name
Your answer
Relationship to young person
Your answer
Second Emergency Contact Phone Number
Your answer
If the young person is under 16 do you give permission for your child to travel / walk home on their own at the end of the day?
Does the young person have any disability needs? If yes, please give details
Your answer
Does the young person have any behavioural needs? If yes, please give details
Your answer
Does the young person have any dietary requirements, including any allergies? If yes, please give details
Your answer
Does the young person require any additional support? If yes, please give details in as much information as possible e.g what sort of support works well for your young person to enable them to engage positively with a group session.
Your answer
Do you give permission for photographs of the young person to be used for publicity at Ark-T? e.g. on flyers and on our website
Do you give permission for photographs of the young person to be used by a third party from Ark-T? e.g. the press or partners
Do you / your family / your child have a social worker? (you are not obliged to answer this, but it would be useful to know in order for us to offer you appropriate support)
If so, what is the name of your social worker?
Your answer
Social worker's email address:
Your answer
Social worker's phone number:
Your answer
Are you subject to any of the following:
Other (please specify)
Your answer
Why do you wish your young person to come to Creativity Camps and what do you hope they will get out of it?
Your answer
Signed
Your answer
Date
MM
/
DD
/
YYYY
Would you like to be added to our Creativity Changes Lives mailing list if you are not already on it?
Would you like us to send you a BACS donation form should you wish to make a donation to cover costs of the days?
Submit
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