Exchange Young Creatives 11-14 Sign-Up Form
ONLY PARENTS/GUARDIANS/PARENTS MAY SIGN UP CHILD, if you are 16 or over please use the other form.
Child First name *
Child Surname *
Age *
Date of birth *
Address *
Email *
Phone *
Emergency Contacts and Information
Please ensure you provide us with current emergency contacts for a next of kin / parent / guardian.
Name of emergency contact *
Emergency Contact Phone 1 *
Emergency Contact Phone 2 *
Relationship to you *
Photo Permission
Do you give Ventnor Exchange full permission to use images of your child participating in workshops, which reasonably promote or advertise Ventnor Exchange's Young Creative opportunities. This may include our printed publications; adverts; audiovisual and electronic materials; media work; display materials; and any other media we may use in the future. The images will not be used for any other purpose and are owned solely by the Ventnor Exchange.
Clear selection
Do you suffer from any allergies or illnesses, or are required to take regular medication? *
If so please describe, if none leave blank.
Which School does your child attend?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy