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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?
YesNo

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
YesNo

If YES, 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
YesNo

I give permission for the named young person's video to be used for promotional purposes including, but not exclusively social media
YesNo

Do you accept your details being added to our database for future projects?
YesNo

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