Livewires application form

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Email *

Parent/Carer's name *

Address *

Relationship to child/children *

Child/children's name(s) *

Child/Children's date(s) of birth *

Postcode *

Telephone *

Emergency contact 1 (Name and telephone) *

Emergency contact 2 (Name and telephone)

School attended *

School year group *

Details of any medical conditions for the child/children that you think we should be aware of (eg allergies, asthma)

In the unlikely event of illness or accident, I give permission for any necessary medical treatment to be administered by the nominated first aider, or by suitable qualified medical practitioners. Should my child require emergency hospital treatment, I authorize an adult leader to sign on my behalf, any written form of consent required by the hospital if I cannot be contacted. I understand that every effort will be made to contact me as soon as possible.

Yes

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We may from time to time take pictures of the group, some of which may be used for publicity purposes. Are you happy for us to include your child/children in such images? *

Yes - I am happy for photos of my child/children to be taken and included in any publicity

No - please do not include my child/children in photographs of the group

Would you like to receive a copy of the Holy Trinity weekly email newsletter? *

Yes

Privacy

Your privacy is important to us. UK Data Protection law means that we need your consent, in most instances, for how we contact you and process your data. You have every right to withdraw consent for us to use your data. Our Data Privacy Notice can be viewed at https://www.holytrinityspital.org/privacy-and-cookie-info

A copy of your responses will be emailed to the address you provided.

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