Circus Camp

Your childs' full name

Your name

Your relationship to the child

Phone Number

Your email

Do you consent to your child being photographed and his/her photos appearing on display at Sydney Trapeze School – not for the purpose of advertising?
YesNo

It is important to keep the following information correct at all times as the information can be valuable in an emergency.

Does your child suffer from any of the following? If yes, please provide details.
AllergiesEpilepsy/ConvulsionsAsthmaAnaphylaxisDiabetesOther
If you ticked other above, please provide further details...

Does your child require any form of on-going treatment for anything noted above? Please supply details in full, including how this is managed at home and supply any relevant documentation not able to be included here by email: info@sydneytrapezeschool.com

Does your child have any special needs?
YesNo

If you answered YES to any special needs - diagnosed or suspected - please supply details in full, including how this is managed at home/school (Please supply any relevant documentation relating to behavioral adjustments, medication or other relevant information).

Do you consent to our staff administering First Aid to your child where necessary, using contents of the First Aid Kit when appropriate?
YesNo

In the case of an emergency, do you give permission and consent for our staff to seek out any medical treatment deemed appropriate (e.g. Medical, Dental, Hospital, Ambulance service, etc) and consent to the carrying out of any such treatment for your child?
YesNo

Do you understand that you will accept full liability for the cost of any such medical treatment that is given to your child/children in case of emergency?
YesNo

Emergency Contacts/Collection of Child

Please nominate up to two OTHER people who you authorise to:
- act as ‘Emergency Contacts’ in the event that parents are unavailable
- pick up your child from Sydney Trapeze School

Contact One

Name

Their relationship to the child

Their Phone Number

Pick Up Permitted
YesNo

Contact TWO

Name

Their relationship to the child

Their Phone Number

Pick Up Permitted
YesNo

Is there anyone you do not consent your child to be taken home with?
YesNo

Other Information (optional)