Holiday Club Consent Form

"*" indicates required fields

Child's Name*

First Last

Age*

Address*

Street Address Address Line 2 City County Post code

Emergency Contact*

First Last

Emergency Contact*

Please state below any medical or other information we need to know in order to safeguard the health and safety of your child.

E.g. Allergies, diabetes, epilepsy, medication. If your child needs medication you will have to fill in a medical form on the day.

Please state below any specific dietary requirements your child might have.

Do you give permission for your child to take part in Growing Wild activities.*

Yes

We will sometimes use facepaints. Do you give permission for your child to use face paints?*

Yes

Parent / Carers Name*

First Last

Parent / Carer Email Address*

We also ask permission to take photographs or video footage of your child that may be used for Growing Wild Outdoor Nursery publicity. The images will be used solely by Growing Wild for publicity purposes. They may be used in leaflets, brochures or on the Growing Wild Outdoor Nursery website and facebook page.

Do you give permission for your child to be photographed or filmed for use by Growing Wild?*

Yes

Would you like to be kept informed of future activites?**

Yes

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Let your little ones explore the outside!

Book a place now!