Child Consent Form Child's details Name of child Date of birth Emergency contact number of parent/carer Location Which Discovery Centre or Nature Reserve are you attending? Photography consent Signed I give permission for Essex Wildlife Trust to film / take and use photographs of myself and the child / children in my care, which may be used in publicity; this may include publication by the press, use on our website, social media and printed materials. Photographs will not be used for any other purpose. Confirmed (by parent/guardian/carer) - Select -YesNo In Loco Parentis Name (parent/guardian/carer) Date (of first event) Any other details Please provide any other information about your child which you think we should know. Emergency contact Please give the details of one other person who can be contacted during the workshop in the event of an emergency. Doctor’s name Doctor's telephone number Medical history Please state any medical conditions such as diabetes, epilepsy, asthma etc. Also allergies to food and drugs and any religious/personal considerations of which we or a doctor should be aware. Date of last tetanus injection Information Please note we are not able to administer any medication including sun cream. If your child needs to self medicate please inform the course leader on arrival. As an organisation we inclusively offer our facilities to all. To ensure we meet your child’s needs, please inform us in advance of any special education needs. This information is collected to conform to statutory and legal guidelines and to enable us to comply with our duty of care to those that use our services. This form will be stored securely following our Data Protection guidelines. If you wish this data to be removed after a particular event please notify the leader. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
