Any dietary needs we should be aware of? Yes No Anything else which we should be aware of? Yes No If yes to any of the above, please provide full details e.g. time medication must be taken, if help is required to administer medication, etc. (please use additional paper if required). Emergency Contact Details (if different from Parent/Carer) Name: Relationship to the child or adult: Address: Phone: Contact details: Email: Mobile: Confirmation Name of parent/carer Date or adult (print): Signature: This event only Consent valid for the 1 year 1 week following period Other (please detail): (please circle) 1 month
Any dietary needs we should be aware of? Yes No Anything else which we should be aware of? Yes No If yes to any of the above, please provide full details e.g. time medication must be taken, if help is required to administer medication, etc. (please use additional paper if required). Emergency Contact Details (if different from Parent/Carer) Name: Relationship to the child or adult: Address: Contact details: Phone: Mobile: Email: Confirmation Name of parent/carer or adult (print): Date Signature: Consent valid for the following period (please circle) This event only 1 week 1 month 1 year Other (please detail):