confidential data sheet (day camp)

It is important that we have the correct contact details and information for everyone at day camp.
Please complete this Data Sheet fully using a separate one for each child.

Child’s Name Date of Birth / /

Home Address

Postcode Home Telephone Number ( )

Parent or Guardian’s Name(s)

Home Address (if different from above)

Postcode Home Telephone Number ( )

Mobile Telephone Number ( )

Relationship to Child

In the event of an emergency if we were unable to contact you on any of the above numbers, an additional
contact would be helpful.

Alternative Contact Name

Alternative Contact Home Telephone Number ( )

Alternative Contact Mobile Telephone Number ( )

Relationship to Child

Doctor’s Name
Surgery Address

Postcode Surgery Telephone Number ( )

Care Information (Please give us details of any allergies, special needs etc or any other information that
you think will make your child’s time at day camp as enjoyable as possible)

Insurance
We hold full cover for public liability. However, we do not accept responsibility for any personal property
that becomes lost or damaged.
Photography/Recording
I understand that parents may also be allowed to take photographs and record the performance on Friday
afternoon for their own private and personal use.
I understand that if I take photographs or record this performance, it is for my sole personal use and must
not be used for any other purpose including uploading to the Internet.
 I give my permission for my child to be included in photographs/recordings
 I do not give my permission for my child to be included in photographs/recordings
Face Paints
Occasionally we use Snazaroo face paint at day camp. They are high quality, hypoallergenic, non-toxic and
easy to remove. You can find a Safety Data Sheet at: www.snazaroo.com.
 I give my permission for my child to use face paints at productions/workshops
 I do not give my permission for my child to use face paints at productions/workshops
Plasters
Sometimes children have a bump or scrape that needs a plaster. We are not allowed to give these without
your permission.
 I give my permission for my child to have plasters
 I do not give my permission for my child to have plasters
Medical
In the event of illness or accident you will be contacted immediately. If this is not possible, an ambulance
will be called and your child will be sent to hospital with a crew member.
Behaviour
High spirits are welcomed, but if a child is continually disruptive, we reserve the right to suspend or
exclude them. No refund will be given.
Medication
I will notify The Man In The Moon of any specific medication that may need to be administered to my child,
and understand that I will need to complete an additional consent form.

Parent/Guardian Signature

Date

The Man In The Moon  Passfield Business Centre  Lynchborough Road  Liphook  GU30 7SB
Telephone 01428 751656  Web www.themaninthemoon.co.uk 01/11