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21st August 2024 Farm Club Emergency Contact Form
You must complete this form before purchasing a ticket to Farm Club
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* Indicates required question
Child's details
Please enter the details of the child who will be attending
Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Gender
*
Your answer
Age
*
Your answer
School name
*
Your answer
School year
*
Your answer
Parent/Carer 1's details
Please enter the details for parent/carer 1
Name
*
Your answer
Home telephone number
*
Your answer
Mobile number
*
Your answer
Email address
*
Your answer
Parent/Carer 2's details
Please enter the details for parent/carer 2
Name
Your answer
Home telephone number
Your answer
Mobile number
Your answer
Email address
Your answer
Child's medical information
Doctor's name
*
Your answer
Telephone number
*
Your answer
Medical information that we need to be aware of (Allergies, S.E.N.D., behavioural issues, etc) [If none, please write 'none']
*
Your answer
Authorisation for treatment
I confirm that the above information is correct and I hereby give permission for my child to receive emergency medical treatment or First Aid in the event of staff being unable to contact me.
*
I confirm
Consent for photographs and information
Photographs of our activities are really valuable to us for use in publicity including our web page, displays and leaflets. It also provides evidence to any sponsors that we may have received. Please feel reassured that we would not pass the photos on to anyone else therefore would like your consent in allowing us to use any photos taken for the purposes listed.
I consent
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Check this box if you are happy for us to keep this information for future sessions
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