Woodnook Pioneers – Prospects

DATE	TIME	ACTIVITY	LOCATION
Monday 20th December	11am-2pm	Campfire Cooking	Woodnook Community Garden
Tuesday 21st December	11am-2pm	Campfire Cooking	Woodnook Commnity Garden
Wednesday 22nd December	11am-2pm	Wild Walk	Woodnook Community Garden

Woodnook Pioneers Booking Form

Booking Form for Woodnook Pioneers

Email address:*
Email address we can use to confirm your booking
Confirm email address:*
Email address we can use to confirm your booking
Child's First Name:*
First name of child as it appears on the school register.
Child's Surname:*
Child's surname as it appears on the school register.
Child's Preferred Name:
To ensure all children feel comfortable, please write the name they prefer to be addressed by e.g. Charles may prefer Charlie.
Child identifies as:*
- She/Her
- He/Him
- They/Them
To ensure all children feel comfortable, please tick their preferred pronouns.
Child's Date of Birth (dd/mm/yyyy):*
Please write in the format dd/mm/yyyy e.g. 01/08/2021.
Child's Address*
Please write the address where the child lives the majority of the time.
Postcode:*
Please write the postcode of the address where the child lives the majority of the time.
Emergency Contact First Name:*
If the child had an accident, what is the first name of the person we should contact?
Emergency Contact Surname:*
If the child was injured, what is the surname of the person we should contact?
Emergency Contact's Relationship to Child:*
What relationship does emergency contact have to the child e.g. parent, grandparent, support worker
Emergency Contact's Phone Number:*
Activity Session:*
- Mon 20th December - 11am-2pm
- Tues 21st December - 11am-2pm
- Wed 22nd December - 11am-2pm
Please tick all sessions the child wishes to attend. You can select multiple. Please note sessions on the same day repeat activities.
Allergies
If your child has any allergies, please write them down. If not, please write n/a
Photo Consent for Child:*
- I do consent
- I do not consent
The Prospects Foundation and its funders would like to take photos and film children during Woodnook Pioneer sessions. These images would be used for: • Case study film about the Woodnook Pioneer program • Social media posts by Prospects Foundation and Hyndburn Leisure • Funding report shared with funder • Prospects Foundation annual report Please tick whether you DO/DO NOT consent for us to use images of the child.
Change of Consent:*
- I understand
You can change your mind about the use of the child's image at any time by emailing info@prospects.foundation.org.uk
Free school meals:*
- Yes, they receive free school meals
- No, they do not receive free school meals
Does the child usually receive free school meals?
Permission to share information*
- I give permission for the information on this form to be shared with Hyndburn Leisure
- I do not give permission for the information on this form to be shared with Hyndburn Leisure
Children entitled to free school meals can receive a free packed lunch at every Woodnook Pioneers event. In order for the child to receive a free packed lunch, we need to share the information on this form with Hyndburn Leisure (suppliers of the packed lunch).
Name of school child attends:*
What school does your child go to?
School Activity Code:
You should have been given a School Activity Code by your school. Please enter the code her. If you do not have a school activity code, we will need to see evidence that your child is entitled to free school meals e.g. Universal Credit. Leave this box blank and you will be contacted by a member of Prospects staff.

Sign up to our Newsletter

Woodnook Pioneers Booking Form