PARENT / GUARDIAN / CARER CONSENT FORM

1. CHILD'S DETAILS

11%

YOU should be the Parent, Guardian or Carer for a CHILD who is about to attend one of Deen City Farm's holiday programmes.

Please complete the form carefully.

YOU should complete the form at least 48 hours before the CHILD is to attend. The information YOU provide will be re-presented on our standard consent form so that it can be signed off when your CHILD is brought to the Farm.

Thank you.

*
1. Please enter details for the CHILD

Please enter details for the CHILD First Name:
Surname:
Building Name & Flat No (If Applicable):
House No:
Street:
City/Town:
Post Code:

2. Sex of CHILD

Sex of CHILD Male

Female

*
3. Date of Birth of the CHILD

	DD		MM		YYYY
Date of Birth	Date of Birth of the CHILD Date of Birth Day	/	Month	/	Year

PARENT / GUARDIAN / CARER CONSENT FORM

1. CHILD'S DETAILS

*1. Please enter details for the CHILD

2. Sex of CHILD

*3. Date of Birth of the CHILD

*
1. Please enter details for the CHILD

*
3. Date of Birth of the CHILD