Workshops Booking Form
FLEET ARTS Children’s holiday arts & crafts workshops for ages 5 – 11 yrs
Information will be posted as workshops occur.
Please post your completed booking form to the address below, drop it through our letterbox or bring it in to the office (open Mon/Tues/Thurs 9.30 – 1 & 1.45 – 3.15.) with the payment – cash or cheques made payable to ‘Fleet Arts’.
Please contact us if you haven’t got a booking form and we can email or send one to you.
Fleet Arts, The Fleet, Belper, Derbyshire DE56 1NU v 01773 820484 v jane@fleet-arts.org This project has been made possible through a grant from Belper Town Council
registered charity no 516342 registered company 18889
BOOKING FORM
NAME OF WORKSHOP…………………………………………………DATE OF WORKSHOP…………………………………………
PARTICIPANTS NAME………………………………………………………………………………………………………………
ADDRESS………………………………………………………………………………………………………………………………
…………………………………………………… POST CODE……………………………….………………………………...
HOME PHONE ……………………………. DAYTIME CONTACT……………………………………………………………….
Email address……………………………………………………………………………………………………………………………
DATE OF BIRTH……………………………………………………………………………………………………………………..
SPECIAL REQUIREMENTS eg medication/diet/educational needs ………………………………………………………………
DOCTORS ADDRESS/PHONE No………………………………………………………………………………………………….
Is this your child/s first time at a Fleet Arts Workshop? YES/NO
Under 18’s To be completed by Parent/guardian
1. Do we have your consent to the use of any emergency medical treatment necessary, including the administration of anesthetics, during the course of the event? YES/NO
2. Do we have your consent to take the child to the nearest doctor/A&E Hospital? YES/NO
3. Do we have your consent to apply plasters should the need arise? YES/NO
4. Is your child fully vaccinated? (see list below and delete as appropriate).
MMR....YES/NO DIPTHERIA....YES/NO POLIO....YES/NO HIB....YES/NO
MENINGITIS C....YES/NO TETANUS....YES/NO WHOOPING COUGH....YES/NO
The above is just for information in case of outbreaks.
Signed……………………………………….
POLICY ON USE OF PHOTOGRAPHS
During most activities, photographs are taken of the activity. These may be taken by both Fleet Arts Staff or the Press. They may be used in the future for both publicity and documentation. People are identified in photos used by the press. If parents/guardians do not wish their children to appear in photographs they are asked to ensure that the Staff are made aware of this at the time of booking.
PLEASE SIGN BELOW
YES...............................................................I give permission for photographs
NO................................................................I do not give permission for photographs
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