Holiday club registration form | Filthy Squirrels Woodland Nursery

Child's name

Address

Date of Birth

Gender

Name of parent or guardian (Main contact)

Email Address

Contact Number

Relationship to child

Address

Same as child

different

Address if different

Second Contact Name

Email Address

Contact Number

Relationship to child

Address

Same as child

different

Address if different

Doctor’s Name

Surgery Address

Surgery Phone Number

Does the child have any medication conditions, disabilities, additional support needs or receive regular medication?

Yes

No

If yes, please give details.

I declare my child physically fit to participate at Filthy Squirrels Woodland Nursery activities. I understand that there is an element of risk and I accept that. In the case of an incident, I give permission for First Aiders to treat my child. In the event of any change I will inform Filthy Squirrels.

Yes, I give my permission

No I don't give permission

I accept that personal belongings are not covered by Filthy Squirrels insurance and that Filthy Squirrels will not be held responsible for damage to, or loss of these items.

I accept

Photos and videos are taken during our sessions. These are used for assessing, evaluation and monitoring processes. At times, they may also be used in our marketing, publicity and website including social media. I give permission for these photos to be used in marketing and social media.

I give my permission

I don't give my permission

The information on this form is covered by the ICO and will be entered onto our computer for the purpose of Filthy Squirrels Administration only.

Name

Date

I consent to my personal email being added to the Filthy Squirrels Mailing List. This will be used to provide you with information. At no time will your email be given, sold or passed to a 3rd party without consent.

I consent

The Threshing Barn, Unit 8,

Fifield Bavant,

Wiltshire, SP5 5HT