Confidential Data Sheet (Day Camp)

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


Childs Name Date of Birth / /

Home Address




Postcode Home Telephone Number

Mothers/Carers Name

Mothers/Carers Mobile Telephone Number


Fathers/Carers Name

Fathers/Carers Mobile Telephone Number

In an emergency, if we were unable to contact you, an additional contact would be helpful.

Alternative Contact Name

Alternative Contact Telephone Number

Relationship to Child

Doctors 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 childs time at day camp as enjoyable as possible)











please dont forget to turn over ..
The Small Print Bit

Insurance
We hold full cover for public liability. However, we
are unable to accept responsibility for personal
property that becomes lost or damaged.

Face Paints
Occasionally we use face paints 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 permission for my child to use face
paints.
! I do not give permission for my child to
use face paints.

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.

Photography/Recording
On occasion, we take photos or videos of the
children taking part in day camp. These images and
recordings may be used for display purposes,
printed publicity material, uploaded to our website
and to social media sites (such as Facebook,
Twitter and YouTube). We will only include your
child with your permission, given below, and will
never mention childrens names.
On occasion, parents may be allowed to take
photographs and record performances for their
own private and personal use.
You understand that if you take photographs or
record performances (when permitted), they are
for your sole personal use and must not be used for
any other purpose including uploading to the
Internet.
! I give permission for my child to be
included in photographs/recordings.
! I do not give permission for my child to
be included in photographs/recordings.

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.

Equal Opportunities
Our workshops are open to any child regardless of
gender, race or disability, subject only to availability
of places.

Plasters
Sometimes children have a bump or scrape that
needs a plaster. We are not allowed to give these
without your permission.
! I give permission for my child to have
plasters.
! I do not give permission for my child to
have plasters.

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/Carer Signature

Date / /

The Man In The Moon, Passfield Business Centre, Lynchborough Road, Liphook GU30 7SB
www.themaninthemoon.co.uk Telephone: 01428 751656 06/13