Summer of Fun Booking Form
Hafren Nature Adventures
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Email *
Name of activity *
Date of activity *
Please tick which time slot your child is attending *
Name of young person *
Age and DOB *
Home address *
Parent/Guardian name *
Mobile contact number *
Relationship to the child *
If a parent is staying with the child for the session, please provide an alternative emergency contact *
Does the young person suffer from any allergies? If YES, please give detail *
Some of our activities include foraging and cooking, does the young person have any dietary requirements? If YES, please give details *
Is the young person on any medication? If YES, please give details *
Does the young person have any additional needs that may affect their participation in the activities? If YES, please give details *
Who will be accompanying/dropping off and picking up the young person *
I agree to authorise any member of staff during this activity, to approve such medical treatment for my child as is deemed necessary in an emergency, or upon the advice of qualified medical practitioner, if I cannot be contacted *
I understand that all activities will take place outdoors and that I will provide adequate clothing and footwear and that I have declared any physical ailments, conditions or injuries which may have a negative impact on my child’s participation. I understand if the participant is deemed to be wearing unsuitable clothing/footwear, or not following health & safety instructions, they may be turned away from the session *
I agree that any photos, film, audio, or crafts made by me, or my child produced during this session may be used by Open Newtown to promote the Hafren Nature Adventures programme.  *
Required
I have read and agree with the terms set out in Open Newtown’s Privacy Notice *
I consent to my child/children taking part in the Hafren Nature Adventures sessions *
parent/guardian signature (e-signature accepted) *
Demographic questions
Our funders have asked us to collect the following information. This will help more free activities run in the future.
If you do not wish to share the following, please ticket “prefer not to say”
How does your child identify?
Clear selection
How would you describe your child’s ethnic origin?
Clear selection
A copy of your responses will be emailed to the address you provided.
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