Allergy and Photography Consent Form

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What is your child's name? *

Does your child have any allergies? If so, what are they?
*

What is your child's date of birth?
*

YYYY

Emergency contact information 1:

Please provide a name, relation to child, address with post code, email and phone number

Emergency contact information 2:

Please provide a name, relation to child, address with post code, email and phone number

What is your child allergic to?

Is your child an EpiPen carrier?

Yes

Clear selection

If yes to the above question, what date does your child's current EpiPen expire?

YYYY

Does your child require any medication for their allergies?

What constitutes an emergency for your child? What action should be taken if this occurs?

Is there any other information about your child's allergies that you would like us to know?

I: *

agree that the medical information in this form may be shared with individuals involved with the care and education of my child

understand that I must immediately notify The Neighbours Upstairs team, in writing, if there are any changes to the information provided on the form

Required

Do you consent to us using your child's image being used by us, directly and privately with other child entertainment and education bodies? *

Yes

Do you consent to us using your child's image being used by us on our social media platforms?
*

Yes

Form completed by:
*

Relation to child:
*

Date completed:
*

YYYY

Submit

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