King’s Kids Away Day Consent Form May 04 2016| 0 comments | Category : Uncategorized PAYMENTI have already...* clicked BOOK HERE and have my ticket(s). spoken to Ben and have agreed a payment plan. The form you are about to fill out does not guarantee a place at the event. Only making a payment or arranging a payment plan can guarantee a place!CONTACT DETAILSFull Name of Child* First Last He/She likes to be called...Date of birth of Child* DD MM YYYY Age at time of event*Name of Person filling in this form* First Last Relationship to the child*Your Email Address* Your Daytime Phone Number*Your Evening Phone Number*This may be the same as above, but please enter the number again so we can easily identify which number to try first in the evening should we need to contact you.Your Mobile Phone Number*If you do not have a mobile phone yourself, please provide the mobile phone number of a family member.YOUR ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name of Emergency Contact Person* First Last We will try to contact yourself in the first instance, but please list here the person you would want us to contact if we cannot reach you.Relationship of Emergency Contact Person to the child*Phone Number for Emergency Contact Person*Name of Family Doctor*Address of Family Doctor*Phone Number of Family Doctor*GROUPINGBoy / Girl*BoyGirlSchool Year*Year 3 - RocketsYear 4 - RocketsYear 5 - XplosionYear 6 - XplosionIf there is another child (or children), of the same gender and of similar age, whom your child would appreciate being in a group with, please give their name(s) here:MEDICAL INFORMATION1. I give permission for my child to receive medication as instructed.*NoYes2. In the unlikely event of illness or accident I give permission for my child to receive any medical treatment that a First Aider deems necessary.*NoYes3. If for any reason I am unable to be contacted, I also give permission for any Dental Treatment to be given as considered necessary by the medical authorities present.*NoYes4. If for any reason I am unable to be contacted, I also give permission for any Emergency medical or surgical treatment, including anaesthetic, to be given as considered necessary by the medical authorities present.*NoYes5. Does your child have any DRUG allergies?*NoYesIf yes, please give details here...* 6. Does your child have any NON-FOOD allergies?*NoYesPlease give further details here...* 7. Does your child carry an EPIPEN?*NoYesIf yes, please give details here...* 8. Does your child carry an INHALER?*NoYesIf yes, give details here...* ***IMPORTANT*** If your child has an inhaler, he/she MUST bring 2, one for the First Aider as well as one for your child. Without an inhaler, your child will not be able to participate in activities, as experience tells us that it is sometimes hard to find inhalers in a hurry! Please also be aware that Oakwood Activity Centre is a woodland area, so HAYFEVER medication is more likely to be needed.10. Does your child suffer from...* Asthma / Wheeze? Diabetes? Nervous Disorders? Migraines? Epilepsy? Hayfever? Nose Bleeds? Severe Headaches? Faints? Any other ailment / disability which requires special attention? NONE OF THE ABOVE Tick all that apply OR select "None of the above"Please give further details...* 11. Please mention here any concerns or other information which may be helpful, to enable the leaders to give the best care for your child, OR TYPE NONE.* e.g. toileting issues, bedwetting, night terrors, behaviour issues, home sickness, etc The more information we have the better!12. Please list here details of any regular medication your child takes, including dosage and frequency, OR TYPE NONE.* Please notify us prior to camp of ANY changes. Ensure your child brings ALL listed medicines IN THEIR ORIGINAL PACKAGING, making sure they are NAMED clearly and with clear instructions as to the dosage and frequency required, etc. 13. If your child has a simple form of pain (e.g. headache), which painkillers (e.g. Paracetamol) would you normally give him/her, in which form (e.g. tablets, syrup) and in what dosage?*14. Please select any medications that you DO NOT WANT to be used to treat your child should he/she feel unwell or need First Aid.* CalPol (Six Plus) Paracetamol Tablets Ibuprofen (Nurofen Syrup) Antihistamine (Piriton Syrup) Throat Lozenges (Tunes, Strepsils, etc) Fabric Plasters Hypo-Allergenic Plasters Micropore Tape Antiseptic Cream Antiseptic Wipes Antiseptic Spray (Savlon Dry) Arnica Cream (for bruises) Insect Repellent Sun Tan Cream After-Sun Lotion (Calamine) NONE OF THE ABOVE Tick all that apply OR select "None of the above"If any of the above are selected, please give alternatives for each selected.* DIETARY REQUIREMENTS1. Does your child have any food / drink allergies or intolerances?*NoYesIf yes, please provide full details regarding the allergy or intolerance, and list any foods that your child is not allowed to eat.* 2. Are there food alternatives that you give to your child?*NoYesIf yes, please provide full details.* 3. Does your child have any other special feeding or dietary requirements?*NoYesIf yes, please provide full details.* PHOTO / VIDEO CONSENTDuring the week, photographs and video footage may be taken of your child. This will ONLY be used for advertising King's Kids in the future and/or reporting purposes within King's Church.1. May we use your child's image to display activities on our noticeboard or in Powerpoint presentations to the church?*YesNo2. May we use your child's image on our website and/or printed publications?*YesNoThird Choice3. May we use your child's image in recordings that will be used in church meetings to inform the church of all we do in King's Kids, and/or in communication with the Children's Homes in Nepal?*YesNoPARENTAL CONSENT* I agree to the child listed above being allowed to take part in King's Kids Filming Day, and agree to his/her taking part in any or all of the activities. I understand that, while away on Wednesday 25 October 2017, he/she will be under the control and care of a King's Kids Group Leader, Ben & Claire Morton and/or other adults approved by King's Church and that, while these people will take all reasonable care of my child, they cannot necessarily be held responsible for any loss, damage or injury suffered by my child during, or as a result of, this event. SubmitPlease click 'Submit' and then check that there are no additional fields to complete. If your booking has been completed then you will see a confirmation message in the place of this form when the page has refreshed, and will also receive confirmation by email.