CAPA Dance @ Penryn College

Child Name *

Child's DOB *

Emergency Phone Number *

Child's School *

If your child has an EHCP (Education and Health Care Plan) or will need additional support, please provide detail here: *

Does he/she have any dietary needs? *

Does your child suffer from any allergies, or have any diagnosed illness that may affect participation? *

Is your child receiving any medical treatment at the moment? *

For children under the age of 12: Photos of participating children may be taken for use in the local press, Edventure promotions or website and social media. Do you give consent for this? * Yes
No

Your child's details will be stored on a secure database. This information will be used to contact you in the need of an emergency and used to contact you about future activities. Do you consent to this? * Yes
No