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KNOWSLEY EASTER #HAF24 REGISTRATION FORM

To enrol in an Activate Body and Mind program, you must fill out the enclosed registration form.

The form should be filled out in its entirety before attending, as any missing information may delay the registration process and potentially result in not securing a place.

YOUNG PERSON DETAILS
Gender
Gender
Gender
Is your child eligible for free school meals?
Please select which day you are registering for, if registering for multiple days, please select all days that apply;
Does the child /young person have any medical conditions we need to be aware of?
Does the child / young person have any allergies we need to be aware of?
Does the child / young person have any SEND or additional needs we need to be aware of?

Activate Body and Mind take photographs / videos of children who attend our events / programmes to be used in our group publicity (including our social media pages, website, and any promotional material to support and promote future events and to help us continue to deliver free camps). Once we no longer need images for publicity purposes, we will delete them. Does Activate Body and Mind have permission to include your child/ren?

*Consent can be withdrawn at any time by emailing us at info@activatebodyandmind.co.uk If consent is withdrawn, we will delete the photograph or video and not distribute it further.

We’d love to keep in touch and provide you with details of our future programmes and events. If you

are ok for us to email you in the future, please add your email address below:

Informed Consent and Acknowledgement - I give permission for my child to participate in Little KiHitters organised by Activate Body and Mind, including all the activities involved. I understand that although staff or leaders in charge of the project/activities will take all reasonable care of participants, they cannot be held responsible for any loss, damage or injury my child suffers as a result of the event.

Consent to Emergency Medical Treatment - Activate Body and Mind will contact you before the commencement of any medical treatment, should this be necessary, unless your child's condition is such that immediate treatment is required before contact with you can be made. Please check the box below to confirm you authorise Activate Body and Mind to consent to any X-ray, examination, anaesthetic, diagnosis, treatment, and/or hospital care that may be recommended for your child/ren by a licensed physician.

I understand that my child needs to follow the behaviour code and any safety rules so that Activate Body and Mind can keep them and other children safe.

Please note that parents / guardians will be contacted to pick up their child / children before the end of the session should they use inappropriate language, or violence towards staff or other children

Please confirm you are accepting of the above information by acknowledging and signing below.

PARENT / GUARDIAN / CARER EMERGENCY CONTACT DETAILS
MEDICAL CONDITION DETAILS
ALLERGY HISTORY / INFORMATION
ADDITIONAL NEEDS
PHOTOGRAPH / IMAGES DISCLAIMER
MARKETING CONSENT
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