Untitled - Ecclesfield School

DATA PROTECTION ACT: We will keep all your information in accordance with the ... Act. This means it will not be used for any purpose outside the ULTIMATE ...
2MB Sizes 2 Downloads 126 Views
ULTIMATE ACTIVITY CAMP Booking Form (ONE FORM PER CHILD)

PLEASE COMPLETE THIS FORM IN CAPITAL LETTERS

Has your child had a tetanus injection in the last 5 yrs?

Yes/ No

Will your child be bringing any medication with him/her?

Yes/ No

If Yes, please tell us what this is and when it should be administered:

DATA PROTECTION ACT: We will keep all your information in accordance with the Data Protection Act. This means it will not be used for any purpose outside the ULTIMATE ACTIVITY CAMP (UAC) without your permission and will be destroyed after UAC.

Child’s Name:

Child’s Date of Birth:

Name of Parent/Guardian:

Contact Telephone Number:

Email Address:

EQUIPMENT: All specialist equipment will be provided, however all children must be dressed in appropriate sportswear to take part in the activities described. LUNCHTIMES: A packed lunch and any drinks/snack needed for the day should be brought with children on the day as there are no catering facilities available on site PHOTOGRAPHS AND VIDEO RECORDING: During the UAC activities photographs/videos may be taken which may be used to publicise future UAC’s in the press, on the Ecclesfield schools website and approved partner websites.

Address:

Please tick if you DO NOT wish your child to be photographed

Post Code:

Any item of value brought to an activity is done so, solely at the owner’s risk. Ecclesfield Secondary School takes no responsibility for the loss of any items during the UAC.

Which school does your child currently attend?

BOOKING AND PAYMENT DETAILS:

ADDITIONAL EMERGENCY CONTACT DETAILS

Please tick which dates you wish to book your child onto – you will receive an email confirmation to the email provided:

Should you be unavailable please give the contact details of someone we can contact in case of an emergency. Contact Name: Relationship to child:

22 March 2016

29 March 2016

31 May 2016

26 July 2016

02 August 2016

09 August 2016

16 August 2016

23 August 2016

No bookings will be accepted without full payment.

Contact Telephone Number:

I enclose full payment for the selected camp dates

(tick to confirm payment attached)

PARENTAL AGREEMENT Address:

Please read the information below carefully. I, ………………………………………………………………. (Parent/Guardian) understand the need for my child

Post Code:

……………………………………………………………………………. to behave appropriately during any activities. I understand that should he/she not do so, I may be asked to collect him/her to take home and he/she

Does your child have any allergies (inc food allergies), medical conditions or any behavioural issue we need to be aware of? Yes / No

may not be allowed to attend any further UAC activities.

If Yes, please let us know what they are:

Signed: ……………………………………….............................................……

(Parent/Guardian)

Date:............................................... Please return the completed form, along with payment, to the main school reception at Ecclesfield Secondary – FAO the Ecco Zone Team.