Select one*
Sikorski Predszkole 3-5 yearsSikorski Szkoła 5-12 years

Child's FULL name*

Date of birth*

Address*

Doctor's name and phone number*

Any medical conditions or allergies?

Parent/Guardian's name*

Address (if different from above)

Your email*

Your mobile number*

Emergency contact name and number*

Child safety: I agree to ensure that only a trusted adult over the age of 16 years will collect my child
Name and mobile of any named adult with permission to collect child

Media Consent
The Society can be approached by both television and newspapers with regard to filming and photographing, we also post photos of our Society events on our Facebook pages and website.
It is crucial that we know if your child cannot be included in any such event.
I hereby consent that my child can be filmed or photographed during events in the Sikorski Polish Club*
YESNO

General Consents
I give permission for my child.. (select ALL that you give permission for)
to participate in special eventsto eat party food provided by the societyto have their face paintedto go on local outings

I agree to abide by the Health & Safety and Child protection rules of the Sikorski Predszkole/Szkoła, I have also read and agreed to the society's privacy notice for data protection.
PLEASE SIGN THE FORM BY TYPING YOUR FULL NAME BELOW (PARENT OR GUARDIAN) AS CONSENT*