Confirmation of Details

Parent/Carer: Please complete the below form to update details for you and your child:

CHILD INFO

Child's Name

First Name

Last Name

Other name(s) known by:

Child D.O.B:

Address (incl postcode):

PARENT/CARER INFO

Parent/Carer 01 Name:

First Name

Last Name

Parent/Carer 01 Phone (home):

Parent/Carer 01 Phone (work):

Parent/Carer 01 Phone (mobile):

Parent/Carer 01 Address:

Parent/Carer 01 Email:

Parent/Carer 01 - Do you have parental responsibility?

Yes

Parent/Carer 02 Name:

First Name

Last Name

Parent/Carer 02 Phone (home):

Parent/Carer 02 Phone (work):

Parent/Carer 02 Phone (mobile):

Parent/Carer 02 Address:

Parent/Carer 02 Email:

Parent/Carer 02 - Do you have parental responsibility?

Yes

EMERGENCY CONTACT DETAILS

Emergency Contact 01

Please include; name, relationship to child, mobile phone, home/work phone, email

Emergency Contact 02

Please include; name, relationship to child, mobile phone, home/work phone, email

MEDICAL & HEALTH DETAILS

Doctor's name and address:

Doctor Phone:

Medical information, including medication:

Does your child have a care plan or any special health needs?:

Allergies:

Dietary Requirements:

Is there any special family or personal circumstances concerning the welfare of your child that we need to be aware of (e.g. social services)?:

CONSENT

I consent to my child being able to participate in the Forest School activities at GroWild, including but not exclusively tools, fire and woodworking.

I consent for my child to be photographed at GroWild and for these to be used in the child’s achievement books, records.

I consent for my child to be photographed whilst at GroWild and for these to be used for press releases, website, social media, publications, training/ exhibitions.

I will provide a named insect repellent and sun cream for this child.

I will provide named and appropriate clothing for this child, appropriate to the time of year as recommended and ensure my child is wearing the provided waterproofs.

I consent to GroWild staff (who are appropriately qualified) to administer first aid should my child need it.

I consent to update GroWild Kindergarten with any changes to my child’s circumstances – including personal, medical and family.

I consent to GroWild Kindergarten administering liquid paracetamol in the event that my child has a temperature above 38oC. I understand that staff will contact me before administering liquid paracetamol and I will need to make arrangements for my child to be collected from Kindergarten.

I consent to GroWild administering antihistamine in the event of an extreme, unexpected allergic reaction. In this circumstance I understand that GroWild will phone our emergency contacts and the emergency services.

In the event that my child requires immediate medical treatment before I can get to the hospital I hereby authorise the staff member present to consent to any emergency medical treatment necessary to ensure the health and safety of my child on my behalf, including emergency first aid by GroWild staff.

I give consent for my child to receive medical attention in cases of emergency when a parent/carer cannot be contacted, for example a Doctor or Paramedic.

There are ticks and bugs in the woodland all year round. GroWild will NOT accept responsibility for bites, ticks or stings any participants when out in the woodland. This is a natural occurrence of being in a woodland/outdoor space and staff work to reduce risks of bites, ticks or stings where appropriate. The provision of insect repellent and appropriate clothing is the most effective action to reduce the risk of bites, ticks and stings. I consent that I have read and accepted this statement.

I consent to GroWild sharing relevant information about my child with other settings my child has/ is going to attend in order to ensure a smooth and good transition.

I understand that GroWild will share any concerns with the relevant services if they feel my child is at risk of significant harm.

I consent to share relevant information and updates about my child with GroWild staff. This may include information from health services, social services, children’s centre, early years.

I consent to an online Learning Journal to be created and maintained for my child. I understand photographs of my child, in support of their learning and development, will be stored on the journal. These will be used to track their learning and development, and only shared with other professionals, setting or school with your permission, unless there is a lawful reason to share i.e. safeguarding.

I consent to group photos showing my child, being used on the online journal, these may be seen by other parents and adults associated with GroWild in context of celebrating the setting or tracking learning and development. These will only be shared with other professionals, setting or school with your permission, unless there is a lawful reason to share i.e. safeguarding.

I agree not to share, by social media or other platforms, any part of my child’s Learning Journal.

I consent to staff updating my child's Learning Journal at home. This will be done confidentially and with secure log in details.

By agreeing below you confirm the above information is correct and that you give consent for us to hold this information about you and your child.

Name of parent/carer completing form:

First Name

Last Name

Date:

In line with GDPR (2018) please remember you are able to withdraw consent at any time. Please contact the manager to do so.