Summer Scheme Registration

PORTGLENONE ENTERPRISE GROUP (PEG) SUMMER SCHEME REGISTRATION FORM

Select Week

Week 1: 5-8yrs (1 - 5 July)

Week 2: 9-11yrs (22 - 26 July)

Week 3: 12-16yrs (29 July - 2 August)

CHILD’S DETAILS

Medical Conditions

Please list any relevant medical conditions, disabilities, allergies or medication.

Parent/Guardian Details

Address

Address and Postcode if different from child

School Child attends

Emergency Contact

Emergency Contact Name

Emergency Contact Telephone Number

Parent/Guardian Consent

I give consent for my child to fully participate in any PEG activities for under 18s

Yes

I give consent for my child to be transported to and from PEG activities by bus

Yes

e.g. Steamvale Farm, inflatables, ice skating, surfing north coast - further information on parent letters nearer the time

I give permission for my child to leave the community centre at lunch-time (week 3 only: 12-16yr only)

Yes

I give consent to photographs and short videos of activities, including those of my child, to be taken for all forms of publicity used by PEG including social media such as Facebook

Yes

I give consent to any emergency medical treatment to be given as considered necessary.

Yes

NB The medical profession takes the view that a parent’s consent to medical treatment cannot be delegated. Medical consent forms have no legal status and a doctor has the right to insist parental consent before treating a child. We have found, however, that medical staff find this type of general consent helpful.

I understand that it is my responsibility to notify PEG of any changes in circumstances or information in writing as soon as possible so that changes can be made to the existing form or a new form can be completed.

Yes

I give consent to my personal details being held by Portglenone Enterprise Group

Yes

As parent/guardian, please enter your card details for payment thereby confirming consent.

Summer Scheme Registration

Remaining Places