Thursday Art Club Consent Form

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Please ensure you have also booked your ticket for the workshop through www.ragtagarts.co.uk

Parent's Name *

Email *

Mobile *

Emergency Contact Name *

Emergency Contact Number *

Emergency contact relationship to your child *

Child's Name *

Child's Date of Birth *

Does your child have any medical conditions? *

Yes

Required

Please give details of any medical conditions

Does your child have any additional needs?

Autism

Physical disability

Learning disability

Sensory impairments

Other:

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Please give more details of your child's additional needs, and support they may need at the workshop.

Does your child have additional support in school? *

Yes (please give details below)

Other:

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