I give permission for

to attend the MiX and MiXXtra events

Signed
Date ..

(parent/guardian)

In case of emergency, my contact number is:

Any illness/allergies we should be aware of:

.
Details of any medication we should be aware of:
.
We may take photos of the MiX to use for advertising the MiX.
We always ensure that photos conform to our photo policy which
includes not putting names to photos. If you would rather not
have any photos used of your child, please contact
Becca Watkins 07531 017 789
Address: ................................................................
................................postcode ..................
Parent/Guardian
email
...............................................................