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Summer Holiday Programme 2020 Hoxton Hall
In order to ensure the safety of all of our participants this form must be completed fully by all parents/guardians. By filling out this form you give permission for the London Borough of Hackney Youth Service to collect and store personal data about me and the activities which I participate in for monitoring purposes. I understand the data will be held in line with the Data Protection Act 1998 and subsequent updates and amendments.
Please fill out one form per participant.
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Participants First Name
*
Your answer
Participants Sir Name
*
Your answer
Participants Age
*
Your answer
Gender
*
Female
Male
Prefer not to say
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Week One(27th July- 31st July) Morning Session 7-10
YES
Clear selection
Week One(27th July- 31st July) Afternoon Session 7-10
YES
Clear selection
Week One (27th July-31st July) Morning Session 11-15
YES
Clear selection
Week One (27th July-31st July) Afternoon Session 11-15
YES
Clear selection
Week one (27th July-31st July) Morning Session 15-19
YES
Clear selection
Week one (27th July-31st July) Afternoon Session 15-19
YES
Clear selection
Week two (2nd August - 7th August) Morning Session 7-10
YES
Clear selection
Week two (2nd August - 7th August) Afternoon Session 7-10
YES
Clear selection
Week two (2nd August - 7th August) Morning Session 11-15
YES
Clear selection
Week two (2nd August - 7th August) Afternoon Session 11-15
YES
Clear selection
Week two (2nd August - 7th August) Morning Session 15-19
YES
Clear selection
Week two (2nd August - 7th August) Afternoon Session 11-15
YES
Clear selection
Week three (10th August - 15th August) Morning Session 7-10
YES
Clear selection
Week three (10th August - 15th August) Afternoon Session 7-10
YES
Clear selection
Week three (10th August - 15th August) Morning Session 11-15
YES
Clear selection
Week three (10th August - 15th August) Afternoon Session 11-15
YES
Clear selection
Week three (10th August - 15th August) Morning Session 15-19
YES
Clear selection
Week three (10th August - 15th August) Afternoon Session 15-19
YES
Clear selection
Week Four (17th August - 21st August) Morning Session 7-10
YES
Clear selection
Week Four (17th August - 21st August) Afternoon Session 7-10
YES
Clear selection
Week Four (17th August - 21st August) Morning Session 11-15
YES
Clear selection
Week Four (17th August - 21st August) Afternoon Session 11-15
YES
Clear selection
Week Four (17th August - 21st August) Morning Session 15-19
YES
Clear selection
Week Four (17th August - 21st August) Afternoon Session 15-19
YES
Clear selection
Please give details of any participant medical condition or allergies that it would be useful for us to be aware of (e.g. diabetes, epilepsy, asthma, hay fever etc.)
*
Your answer
Please give details of any participant SEN and additional needs.
*
Your answer
Parent/Guardian First Name
*
Your answer
Parent/Guardian Sir name
*
Your answer
Mobile Number
*
Your answer
Email Address
*
Your answer
Postal Address Line 1
*
Your answer
Postal Address Line 2
Your answer
Post Code
*
Your answer
I consent to the participant receiving emergency medical if necessary
*
Yes
No
Are they allowed to go home by themselves?
*
Yes
No
Are they allowed to go home by themselves?
*
Yes
No
I consent to Hoxton Hall using images/video footage of the participant for promotional purposes, including flyers, posters, reports, press, media and on its own website
*
Yes
No
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