Little Fish Summer Programme Registration Form 2019

Attendee Details

Please select: MaleFemale

(This will used for the company to send confirmation of your child’s place on the programme)

Home Address

Alternative Emergency Contact

School Details

I give permission for my child to attend the Little Fish Summer programme, from
29th July – 9th August 2019 (Monday – Friday) 10AM - 4PMTaking Place at: Rye Oak Primary School, Whorlton Road, London SE15 3PD
YesNo

I will be responsible for organizing my child’s travel arrangements to enable them to attend the full 10 days
YesNo

If known, please state how your child will travel to and from the project

I am aware that I and other family members and friends are invited to a showing of my child’s work which will take place on Fri 9th August from 5.30 – 7.30pm at Rye Oak Primary School
YesNo

I agree to provide a healthy packed lunch including drinks for my child on each day of the summer programme (including the trip). Children will not be permitted off site between 10am and 4pm.
YesNo

Does your child have any of the following health problems?
NonePhysical health problemMental health problemLearning disability

If you have ticked any of the above, please explain in detail

Has your child got any Special Needs?
YesNo

If yes, please state (including Statement of Special Needs or any specific issues such as Autism, Emotional Behaviour Difficulties, and Hearing Impairment). This information is for the purpose of staff supporting your child and will not affect them being accepted on the programme:

We need your permission to take photos and video films of the children whilst they are taking part in the Summer Programme. A filmmaker will distribute copies of a final edited video which will be received by all the young people. We will use this media material for marketing purposes on our web-site and social media channels in line with our privacy policy (a copy is available on request).

I give my permission for the use of video and photographic images of my child to be used by Little Fish Theatre
YesNo

If there is any reason that your child cannot be photographed/videoed, please let Suha Al-Khayyat our data protection officer know in advance of the project starting.

Ethnicity

(to provide a break down to our funders)

WhiteBritishIrishAny other white background

MixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed background

Asian or Asian BritishIndianPakistaniBangladeshiAny other Asian background

Black or Black BritishCaribbeanAfricanAny other black background

Chinese or Other Ethnic groupChineseAny other ethnic background

Medical information about your child

Does your child have any condition requiring medical treatment, including medication? YesNo

Is your son/daughter allergic to any medication?YesNo

Your child is required to bring their own healthy packed lunch on a daily basis. Little Fish Theatre will not be responsible for providing food. There will be no access to food onsite and children are not permitted to leave the venue to buy food during the hours of program delivery:


Are there any activities you are aware your child cannot or will not take part in?

Declaration

In case of an emergency, Little Fish will endeavor to contact me and will also call emergency medical services/medical authorities.

I agree

I give my consent for my son/daughter to participate in the activities of the Little Fish Summer Programme and for Little Fish to record these details. Anonymous details will also be shared with our funder, The Big Lottery Fund and our evaluators, but will not be used for marketing any other purposes.
I agree