Easter Holiday Project 7-10

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In order to ensure the safety of all of our participants this form must be completed fully by all parents/guardians. By filling out this form you give permission for the London Borough of Hackney Youth Service to collect and store personal data about me and the activities which I participate in for monitoring purposes. I understand the data will be held in line with the Data Protection Act 1998 and subsequent updates and amendments.

I agree to comply with Hoxton Hall covid safe related rules such as mask wearing for over 11 year olds, abiding by bubble rules set by Hoxton Hall participation department.

Please fill out one form per participant.

Participant First Name *

Participant sir name *

Participant age *

Participant Gender *

Female

Male

Other:

Date of Birth *

YYYY

Tuesday 13th April - Thursday 15th April 2021 *

yes

Ethnicity

Please give details of any participant medical condition or allergies that it would be useful for us to be aware of (e.g. diabetes, epilepsy, asthma, hay fever etc.) *

Please give details of any participant SEN and additional needs. *

Parent/Guardian First Name *

Parent/Guardian Surname *

Parent/Guardian Mobile Number *

Parent Email Address *

Postal Address Line 1 *

Postal Address Line 2

Post Code *

I consent to the participant receiving emergency first aid if necessary *

Yes

Are they allowed to go home by themselves? *

Yes

I consent to Hoxton Hall using images/video footage of the participant for promotional purposes, including flyers, posters, reports, press, media and on its own website *

Yes

Option 1

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