Brocklewood Primary Freedom Factory Consent Form

Child's Full Name

Age

Parent/Guardians name

Parent/Guardians email

Parent/Guardians contact number

Parent/Guardian Postcode

How will your child get home from the session ?

Collected by Parent/Guardian Walk Home Alone Use Public Transport

If you selected "Collected by Parent/Guardian" please state their name, relationship to child and contact number if different from above fields.

Does your child have an Allergy, Disability or Health Condition?

White Ethnicity/Cultural Background

English / Welsh / Scottish / Northern Irish / British Irish Gypsy / Irish Traveller

Black Ethnicity/Cultural Background

African Caribbean

Asian Ethnicity/Cultural Background

Indian Pakistani Bangladeshi Chinese

Mixed Ethnicity/Cultural Background

White / Black Caribbean White / Black African White / Asian

Other Ethnicity/Cultural Background

Arab Other

If other please describe here

Give Consent to Media (Optional)

I am the parent guardian of the above-named child and I give consent to Freedom Foundation to take photographs, film and record my child for promotional purposes. (Please uncheck if you do not give consent to this for your child)

Give Consent to Data Processing

I am the parent guardian of the above-named child and I understand that by signing my child up for these sessions, I give consent to Freedom Foundation to processing this personal data to achieve their educational aims, including registration and ensuring the safety of my child at a Freedom Factory session.

Brocklewood Primary Freedom Factory Consent Form

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