SS Great Britain Trip - Easter HAF 2023

SS Great Britain Trip- Easter HAF 2023
Date: Friday 14th April, Time: 11am - 3pm

Pick up and drop off Ducie Road, Barton Hill Settlement BS5 0AX
Please take care to complete this form in full as the details are necessary for funding.

For further information about HAF visit https://www.yourholidayhubbristol.co.uk/

Click here to view the Holiday Activities and Food (HAF) Programme Privacy Notice
Section 1: Parent/ Carer Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone number*
Email*
Relationship to child / young Person*
Section 2: Emergency Contact
Emergency contact name*

First NameLast Name
Emergency contact address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact phone number*
Please enter a valid phone number.
Emergency contact relationship to child/ young person*
Section 3: Child/ Young Person Information
Name ( As known on school register)*

First NameLast Name
Address ( Permenant place of residence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth *

DayMonthYear
Male or Female*
Full name of school & area base*
Is the child/ young person on benefit related free school meals?*

YesNo
Please add UPN if known
UPN = Unique Pupil Number
Name & address of doctor*
Doctors phone number *
Details of any dietary requirements, allergies or phobias
Details of any medication, medical treatment or needs
Does the child/ young person have any additional needs or require any extra support to engage in these sessions and/ or is there any other information that would be useful for the Coordinator to know?
Would you be happy to be added to an Imayla WhatsApp group?

YesNo
Section 4: Photo and Video Consent

Imayla uses photography and audio recordings to illustrate Imayla’s activities and promote future programmes.
I give permission for photos of my child/ young person to be used to illustrate Imayla’s activities.I give permission for audio of my child/ young person be used to illustrate Imayla’s activities.I give permission for video of my child/ young person to be used to illustrate Imayla’s activities.I do not give permission for any photos, audio or video of my child/ young person to be used.
1. I understand all activity takes place within Imayla's Safeguarding Policy, under the guidance of the South West Safeguarding Procedures.

2. I accept that Imayla's activities sometimes involve a degree of risk-taking. To minimise risk to participants, risk assessments are carried out; skilled, experienced and trained staff lead activities and participants are given clear instructions and demonstrations to minimise the risks.

3. Imayla has Public Liability Insurance which will cover any claims for injury to a participant that is shown to result from negligence on the part of Imayla.

4. Imayla supports participants in the care of their belongings but cannot take responsibility for damage or loss. We advise against bringing any unnecessary valuables. Lost property will be kept at the Imayla office for 1 month following any organised activity.

5. Imayla has completed relevant risk assessments and follows government guidelines to prevent the spread of Covid 19 to keep participants safe.
Name of Parent/ Carer*
Signature*

Clear
If you have any questions about this form please call Sylvia 07738179048 or the Imayla office (Tuesday - Thursday) 07585028609 or email: admin@imayla.co.uk
Should be Empty:

SS Great Britain Trip- Easter HAF 2023

Date: Friday 14th April, Time: 11am - 3pm

Section 1: Parent/ Carer Details

Section 2: Emergency Contact

Section 3: Child/ Young Person Information

Section 4: Photo and Video Consent