Days to attend

Please tick all that apply:
21st November

Child Information

Child's First Name (required)

Child's Last Name (required)

Age at time of course (required)

Date of Birth (required)

FemaleMale

Current School

Current Year Group

Parent/Guardian Information

Parent/Guardian Name (required)

Correspondence Address (including postcode)

Telephone (home)

Mobile

Email (required)

Emergency contact name and telephone number (or 'same as above') (required)

Emergency contact name 2 and telephone number (required)

Please give details of any ailments, allergies or other medical physical condition of which the staff should be aware

Please indicate any special dietary requirements

Photography and Film Permission

Staff may photograph or film participants and staff. Below are listed the places where these photographs and videos may be used:
• the farm’s website
• the farm’s social media channels
• the farm's newsletters
• other marketing and publicity material for the farm
• to local newspapers and magazines
Please indicate your permission below as appropriate (required):

I do give permission for my son/daughter being photographed and filmed for the activities listed aboveI do not give permission for my son/daughter being photographed and filmed

By checking the box below I confirm I am aware that the staff accept no liability for any loss, damage to property or injury arising as a result of my son/daughter’s participation. I know of no medical reason why my son/daughter should not participate. I consent to any emergency medical treatment necessary during the course of the activity session. Completion of this form does not guarantee a place on the course as spaces are limited.

I confirm that I have understood and accept all Terms and Conditions.

Please note your booking won't be finalised until payment has been made.

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