the application by reason of taking part in a performance or activity: of any monies earned by the child during the last twelve months, stating whether the monies earned were in respect of performances or activities for which a licence was granted or a performance for which a licence was not required: Medical declaration to be completed by parent Does your child have: If yes please provide details including any treatment or (answer yes or no) medication: Asthma Any allergies Any skin conditions Hearing impairment Visual impairment Any learning disability Any physical disability Any medical conditions? Taking any regular medication(s)? Been to see or had a referral to a hospital consultant in the last 6 months? I confirm that I have Signature of parent: parental responsibility for this child. Print Name: Postal Address (if different from child) Parents Email Address Parents Telephone No. Date:
the application by reason of taking part in a performance or activity: of any monies earned by the child during the last twelve months, stating whether the monies earned were in respect of performances or activities for which a licence was granted or a performance for which a licence was not required: Medical declaration to be completed by parent Does your child have: (answer yes or no) If yes please provide details including any treatment or medication: Asthma Any allergies Any skin conditions Hearing impairment Visual impairment Any learning disability Any physical disability Any medical conditions? Taking any regular medication(s)? Been to see or had a referral to a hospital consultant in the last 6 months? I confirm that I have parental responsibility for this child. Signature of parent: Print Name: Postal Address (if different from child) Parents Email Address Parents Telephone No. Date:
Child-Entertainment-Licence-application.docx