Child's DOB *

MM

DD

YYYY

Parent / Carer's Name *

First Name

Last Name

Additional Emergency Contact's Name *

First Name

Last Name

Permission for us to share medical/disability information with authorised staff if needed * *

I give permission for Limepalm Ltd to share medical/disability information with authorised staff if needed (e.g. your child’s teacher).

YES

NO

Permission to administer prescribed medication *

I give permission for a First Aider to administer medication prescribed by a doctor. A written record will be kept. An additional form will need to be completed.

YES

NO

Permission to use plasters *

I give permission for the first aid trained staff of Limepalm Ltd to apply plaster(s) to my child if necessary. By agreeing to this you are confirming that your child is NOT allergic to plasters.

YES

NO

If your child has permission to walk home alone please inform us by email *

info@limepalmproductions.com

I HAVE READ AND UNDERSTOOD

Permission to take photographs for marketing purposes *

I give Limepalm Ltd permission to take photos/video during classes, workshops, events and performances for the purposes of marketing, publicity and/or archiving. These will never be shared with any identifying information (age, location etc). There may be times where we will share first names, but only with the explicit consent of the parents.

YES

NO

Parents/carers have permission to film presentations/performances but this is strictly for their personal use and MUST NOT be distributed or shared via any social media platform. Please contact Limepalm Ltd with any queries on this. *

info@limepalmproductions.com

I HAVE READ AND UNDERSTOOD

I, the undersigned, am legally responsible for the child detailed on this form and confirm the information I have supplied is correct to the best of my knowledge *

Please tick to confirm

YES

Digital Signature (parent/guardian) *

First Name

Last Name