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2023-4 WSSA Legacy Leaders Consent Form
Please could you complete the form for your child attending the Legacy Leaders training.
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* Indicates required question
What school does your child attend
*
Choose
Bramber Primary
Broadwater CofE Primary
Chesswood Junior
Downsbrook Primary
Durrington Juniors
Elm Grove
English Martyrs Primary
Goring Primary
Heene Primary
Laurels Primary
Orchards Junior
Our Lady of Sion
St Mary's Primary
Thomas A Becket Junior
Vale Primary
West Park
Whytemead Primary
Pupil First Name
*
Your answer
Pupil Surname
*
Your answer
Pupil Gender
*
Female
Male
Other:
Pupil Date of birth
*
MM
/
DD
/
YYYY
Pupil Ethnicity
*
Choose
Asian or British Asian
Black, Black British, Caribbean or African
Mixed or multiple ethnic groups
White
Other ethnic group
Prefer not to say
Parent/Carer Name
*
Your answer
Parent/Carer Contact Number 1
*
Your answer
Parent/Carer Contact Number 2
*
Your answer
Parent/Carer Email address
*
Your answer
Address (including post code)
*
Your answer
Additional Emergency Contact Name
*
Your answer
Additional Emergency Contact Number
*
Your answer
Photo consent
*
Photos may be used online on the WSSA website and/or Twitter account
Yes
No
First aid consent
*
I agree for first aid to be administered by the WSSA team if needed
Yes
No
Any known medical condition or medication
*
If your child sufferes from asthma please ensure they have their inhaler with them to all session, likewise epi-pens etc.
Your answer
Doctor's details
*
Please include surgery name and phone number
Your answer
Arrangements for collection at the end of the session
*
Please indicate if your child will be collected from Chesswood Junior School (Ladydell Road entrance) or allowed to walk home alone.
Collected
Walk home alone
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