Christmas Camp at West Buckland2020-12-04T14:00:24+00:00

STUDENT CONCENT FORM - CHRISTMAS CAMP AT WEST BUCKLAND SCHOOL 2020

  • STUDENT PERSONAL DETAILS

    • dd/mm/yyyy
  • MEDICAL AND DIETARY INFORMATION

  • Visual ImpairmentHearing ImpairmentAsthmaFaintingHeadachesBed wetting/incontinence 
  • WELFARE INFORMATION

  • PARENT/GUARDIAN CONTACT DETAILS

  • If your answer above is NO, please indicate the number of the person who can speak English in case of an emergency.
  • MEDICAL

  • PUBLICITY

    Country Cousins takes photographs and videos of individuals and groups of students for use in its publicity material and in social media (Facebook and Instagram mainly). Please tick the boxes below if you are willing for the Student to be included in such group photographs/videos.
  • TRAVEL

    Students will have the option to go to some activities outside the school. The student will be accompanied by Country Cousins staff, and measures will be in place for their safety.
  • ADDITIONAL FREEDOM

    There are times where the students have additional freedom, for example when an outing to go shopping. Please tick the boxes below accordingly.
  • DECLARATION

    You must sign and agree before submitting this booking form.
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