French Camp Registration Form

April French Camp Registration

Pirouette cacahouète club
Location :

Wyborne primary school Footscray road SE9 2EH New Eltham
Child Information
Child Name

First NameLast Name
Birth Date

DayMonthYear
Address*

Street Address

Street Address Line 2

Citycounty

postcode
Gender

MaleFemale
Parent/Guardian Information
Name*

First NameLast Name
Phone number
E-mail*
example@example.com
Select the days that the child will attend*

31/031/042/048/049/04
Are you registering for
Drop off Contact's Name if different

First NameLast Name
Relationship
Pick up Contact's Name if different

First NameLast Name
Relationship
How did you hear about us

La marelleGrenadineSocial mediaWord of mouthOther
Have you been refer by someone ?
Please write the name of your referral
Emergency Information
Emergency Contact's Name*

First NameLast Name
Contact number
Relationship*
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed an inhaler? If yes, please explain any instructions.
Does the child have any special needs or requirements?

YesNo
If Yes please specify the special needs
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by less petits molieres ltd during the selected camp. In exchange for the acceptance of said child’s candidacy by less petits molieres ltd, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Les petits molieres ltd . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against les petits molieres ltd. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the les petits molieres ltd . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Payment conditions and informations

- Amount per day :£45

- Time frame 9:30am to 3.30pm

- Extended hours available on requests as extra cost (from 9am to 4:30pm)£60 for all day

- 5% discount for sibling on the second chid.

- 5% discount if child attending more than 2 days.

- Additional Payment Instructions or Conditions:

• Cancellation must be notified 14 days in advance for a full refund.
• No refund will be provided for cancellations made less than 14 days before the start of the holiday club.
• In case of unforeseen circumstances, exceptions to the cancellation policy may be considered at the discretion of the holiday club coordinator.

An invoice will follow when we receive all information required.
=> Sometimes we take photographs or videos of children when they are involved in the activities of our organisation. We may use the pictures or video recordings for our own use and to promote the work of the organisation in the media and on our website. =>To comply with the Data Protection Act 1008 we need your permission to photograph or make any recordings of your child.· =>Do you consent to your child being photographed by our organisation for the purpose of marketing. including on social media:

YesNo
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Are you interested for
Date

MonthDayYear
Date
Signature
Should be Empty:

April French Camp Registration

Location :

Child Information