St Ives Community Orchard Parental Consent Form
We look forward to welcoming your child(ren) at the Orchard! We need this information to keep children in our care safe and happy - please fill out this form ahead of your session. By submitting this form, you confirm that you hold parental responsibility for the child(ren) named below.
Your Name
*
First Name
Last Name
Name on booking (if different)
First Name
Last Name
Child Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Child Name #2
First Name
Last Name
Child #2 Date of Birth
-
Month
-
Day
Year
Date
Child Name #3
First Name
Last Name
Child #3 Date of Birth
-
Month
-
Day
Year
Date
Child Name #4
First Name
Last Name
Child #4 Date of Birth
-
Month
-
Day
Year
Date
Emergency Contact Name:
*
Relationship to Child(ren):
Emergency Contact Telephone Number:
*
Alternative Emergency Contact Number:
Please list any medical conditions, allergies (please specify severity) or dietary requirements you wish us to know about.
In case of emergency this information will be used by the session leader contracted with St Ives Orchard CIC who is qualified to provide first aid as required. It is recommended that your child has an up-to-date tetanus injection
Please let us know if you are happy for the Orchard or session leader to use photographs taken during the sessions in their newsletters, on their website and social media and for publicity purposes. You may revoke this authorisation at any time by sending us a message and it will be removed straight away.
*
Yes
No
Data Protection: St Ives Orchard CIC collects and stores personal information on this consent form for 2 years in line with regulations. Please be assured that none of your details will be passed onto any other party other than session leaders responsible for the care of your child while at the Orchard. Please confirm:
*
Understood
Tick to confirm
*
Submit
Should be Empty: