Permission, Emergency Contact, Medical, Dietary Needs Form

A printable PDF version of this form is available here if you would prefer

Child's Name
Child's Name
Date of Birth
Date of Birth
Parent/Guardian/Carer
Name *
Name
Address
Address
Emergency Contact Information
Please provide 2 emergency contact names and numbers where possible.
Medical Section
Medical Check
Please supply the following medical information and any additional details necessary
Please give details of any other concerns relating to your child’s health e.g. asthma, epilepsy, hayfever, diabetes.
Please give details of additional needs e.g. dyslexia, dyspraxia, ADD, autism.
Please indicate special dietary needs for medical, religious or moral reasons for you and your child.
Photography
We may photograph, or film young people involved in activities which may be used on the Join the Dots Forest School website, Instagram posts and flyers. If you do not wish your child to be included, please indicate here.
Mobile Phone
The use of mobile phones is prohibited except in a case of emergency, agreed photography, or for furthering children's learning - e.g. flora and fauna identification.
Declaration
I agree that (I / my child / ward) will participate in sessions which have been planned by Join the Dots Forest School. I understand that the insurance of Join the Dots Forest School covers all legal liability to all participants of sessions. Join the Dots Forest School regrets that the insurance cover is not available to other organisations. Such organisations are strongly recommended to provide their own insurance for personal injury, loss of possessions or cancellation, which should take effect from the time of booking.
Parent/Guardian/Carer
Date
Date