Child Session and

Activities Consent Form

Please fill out the following form.

Parent/ Carers first name

Parent/ Carers last name

Email

Country/Region

Address

City

Zip / Postal code

Session Or Activities

Childs First Name

Childs Last Name

Childs Date of birth

Gender

Is your child on free school meals?

Yes

No

Not sure

Childs School

Emergency Contact Name

Emergency Contact Number

Emergency Contact Name

Emergency Contact Number

Medical Information.

Dietary needs.

The Bolton Woods Centre aims to provide a safe and enjoyable experience for every child or young person.

To help us do this, please note the following important information.

• Parents and carers must ensure they notify us of any changes to the information given on the form.

• Parents and carers must make arrangements for children to be brought to and from the activity safely and on time. If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so. If there are any issues with transportation, please talk to a member of staff & we will try to help make arrangements between us.

• We cannot take responsibility for any damaged clothing and/or personal items during our sessions.

• Parents and carers should ensure children have sufficient medication (where appropriate) for the duration of the activity.

Concent

I agree to The Bolton Woods Centre keeping record of this form for health and safety reasons.

I consent to being filmed or photographed during the activity. I understand that the photographs or film might be used on social media to promote The Bolton Woods Centre - NOTE If I do not agree to this The centre will not use any images of you.

I agree for my child to take part in sessions at The Bolton Woods Centre.

Please Print and Initial Name.

Signature

Registered Charity No: 1200230

Child Session and

Activities Consent Form