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Young Person's Name

Date of birth of Young Person (DD/MM/YYYY)

Address

Email Address

Parent/Guardian's Name

Parent/Guardian Phone number

Does the young person have any medical needs? Does the young person have any medical needs? Yes No

Please give details of any medical needs of the young person

Please add any dietary requirements including allergies

Please add any information you think would be useful to know

Emergency Contact Name

Emergency Contact Telephone Number

Will the young person will be collected at the end of the session Will the young person will be collected at the end of the session Yes No

Who will be collecting the young person at the end of the session?

I give permission for the named young person’s photo to be used for promotional purposes, including but not exclusively social media I give permission for the named young person’s photo to be used for promotional purposes, including but not exclusively social media Yes No

I give permission for the named young person's video to be used for promotional purposes including, but not exclusively social media I give permission for the named young person's video to be used for promotional purposes including, but not exclusively social media Yes No

Do you accept your details being added to our database for future projects? Do you accept your details being added to our database for future projects? Yes No