3:16 Social - Fri 18th Jan
New to 2019 - Friday night social nights.

By filling in this form you are giving permission for your child to attend the 3:16 social on Friday 18th January.

Once this form is sent you will receive an email with details of the social.

Name of young person *
Your answer
DOB *
Your answer
Parental Consent *
Name of Parent/Guardian
Your answer
Main Emergency Contact & Name *
Your answer
Emergency Contact Number *
Your answer
Second Emergency contact name *
Your answer
Second Emergency contact Number *
Your answer
Parent/guardian email address *
Your answer
Any medical or dietary requirements *
Details of dietary/medical requirements
Please provide details of any ongoing medical or health problems, including any known allergies, and any medication that needs to be taken during the event – e.g. epipen or inhaler please provide information and instructions here.If there are any conditions we should be aware of for the care of your child.
Your answer
In the unlikely event of a serious accident, we will do our best to contact you. It is your responsibility to make sure we have the information we need to do this. If we cannot contact you, do you give permission for your child to receive emergency treatment, including anaesthetic or blood transfusion, as considered necessary by medically qualified people who are involved in any emergency situation? *
I give permission for my child to have paracetamol
*
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