The Vault creative writing after school club

The Club takes place at the LSI Building in Bridport and starts at 3:45pm finishing at 5pm.

PARENTAL CONSENT FORM

Information for parents and carers

The Bank of Dreams and Nightmares aims to provide a safe and enjoyable experience for every child or young person.

To help us do this, please note the following important information.

All questions on the consent form must be completed and signed by the parent or carer before any child takes part.
Parents and carers must ensure they notify us of any changes to the information given on the form.
Parents and carers must make arrangements for children to be brought to and from the activity safely and on time. If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so.
We cannot take responsibility for any damaged clothing and/or personal items during the activity.
Parents and carers should ensure children have medication (where appropriate) for the duration of the activity.

Day activity takes place

Location

Child or young person's details

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child/Young person's email (if applicable)

Parent/Carer's details

First Name

Last Name

Parent/Carer's email

Contact number

In case of an emergency, please contact (only fill in if different from the person named above)

First Name

Last Name

Contact number:

Any extra help we need to provide (for example because of a disability):

Do we need to know about any medical conditions or allergies? (If yes, please provide details for the condition(s) and any medication needed).

Declaration

I am the parent/guardian of the above child, and I approve my child’s agreement and acknowledgement above.

The Bank of Dreams and Nightmares keeping a record of this form for health and safety reasons

Any medical treatment that my child may need being given in an emergency

I understand that my child needs to follow the behaviour code and any safety rules so that The Bank of Dreams and Nightmares can keep them and other children safe.

Additional permissions (Optional)

my child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity.

Date

MM

DD

YYYY