Mission to the Cosmic Frontier Booking Form
July 15th - 18th at Cumnor House School - 9-4pm
Sign in to Google to save your progress. Learn more
CHILD'S FULL NAME: *
GENDER: *
DATE OF BIRTH *
MM
/
DD
/
YYYY
PARENT / GUARDIAN NAME:
 *
TEL NO:
 *

EMAIL ADDRESS:

 *
Child collection
If someone else is collecting your child, other than yourself, please contact Christopher Roche on

07983175554 who will provide you with a password for collection.

MEDICAL: Please specify any medical conditions, allergies or specific needs:  *

EMERGENCY CONTACT DETAILS (If different from above): 

 *
PERSONAL LAPTOP

 *
Yes
No
My child would like to bring their own Laptop for the camp
PARENT/GUARDIAN DECLARATION OF CONSENT
 *
Yes
No
I consent to any medical treatment that is administered the the child named above being recorded in our accident book.
I consent to any emergency medical treatment necessary.
I consent to bite/sting relief being administered as seemed necessary.
I am legally responsible for the child named above and agree to the Terms and Conditions.
PARENTS NAME
DATE
MM
/
DD
/
YYYY
Course Information
When you have booked a place, you will receive full course information and welcome pack.

Drop off/Pick Up: Main Reception

What your child will need each day:

· Comfortable loose clothing (tracksuit/leggings/shorts, t-shirt and a jumper)

What to bring each day:

Insulated lunch bag: ice pack, packed lunch, fruit, 2 substantial snacks (x1 morning & x1 afternoon), a filled water bottle and cutlery for pasta or yoghurts etc. No nuts permitted.

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of MindStorm Coding. Report Abuse
Google Forms