Intake Form - Out to Learn

Out to Learn Intake Form - Under 16

First Name

Last Name

Participant Date of Birth

Participant Gender

Participant Address

Address Line 1

Address Line 2

Town

County

Post Code

Guardian First Name

Last Name

Guardian Contact Email Address

Guardian contact phone number

Please state any allergies.

Please state any special educational needs you feel we should know about.

Please state any physical disabilities so that we can fully accommodate and support you to enjoy your time with us.

Please state any relevant medical information.

Please state any special dietary requirements.

I am happy for my child to use sharp tools under supervision and guidance.

I am happy for my child to work with fire under supervision and guidance.

I am happy for my child to engage in foraging and/or outdoor cooking under supervision and guidance.

Sometimes children find it difficult to follow instructions and may have a tendency to wander off. If the participant fits this description we would be grateful if you could indicate it here.

This applies to my child

Please take a few minutes to watch this safety briefing video with your child before continuing.

I have watched the initial safety briefing video with my child (subtitled if required) and we agree to take on-board any further safety information given during the event.

Out to Learn take your safety seriously and as such our insurers require that you are aware of any potential safety risks, all of which are outlined in our Risk Assessment Policy Document, which you can access here:

OTL Risk Assessment Policy Document.

As an OFSTED registered setting we are required to adhere to stringent safeguarding processes. You can access our Safeguarding Policy here:

OTL Safeguarding Policy Document

You can view our OFSTED registration details HERE.

I have been offered access to both the Risk Assessment and the Safeguarding policy documents.

Having followed the above steps, understand the potential risks and declare that my child is suitable to participate in these activities.

Yes

My child will wear suitable clothing to keep warm and dry outside in all weathers.

Yes

I consent to Out to Learn using photography of my child for promotion.

Yes

I consent to basic emergency first aid being carried out on my if deemed necessary. I understand that my child may remove consent at any time.

Yes

I understand that last minute cancellations/absences cannot be refunded (paid events only).

Yes

Signature

Sign Here

First Name

Last Name

Date / Time

Please tick here if you are completing this form on behalf of a participant aged 16 yrs or below

Data protection is a matter of trust and your trust is important to us. We respect your privacy and personal sphere. We promise that your personal data will never be shared with a third party.