Flame

To register for the Flame Summit please fill in the form below:

Child's Full NameChild's Date of BirthEmergency Contact Full NameRelationship to child/young personEmergency Contact Daytime Number Emergency Contact Mobile Number Do you have parental responsibility for the child/young person? (Yes or No)If not, name and contact details for person with Parental Responsibility Child/Person's Doctor, including the name of the surgery, name of doctor, surgery address, surgery telephone number and child's NHS numberI understand that leaders and helpers will be expected to adhere to the Code of ConductI acknowledge the needs for my child to also behave responsibly and will ensure that this expectation to behave in accordance with the Code of Conduct for Young People is fully understood by my child Does your child have any condition(s) requiring the administration of medications or other treatment? *

My child requires medications and treatment
I confirm that I have discussed management/administration/storage of medications with the event leader
No

Please confirm whether your child has had the governmentally recommended immunisations for their age?

Please state the date of their most recent Tetanus immunisation:Please detail your Child's known allergies:

My child has an EpiPen
I confirm that I have discussed it’s management/administration/storage with the event leader

Please list any dietary requirements, both due to intolerance and personal beliefs:In the event that your child has a fever or is injured and we need to give pain relief, are there specific indications about the type of pain relief used and dosage?Does your child have any additional emotional needs, other than the usual needs of a child their age? For example, have they suffered trauma, have any fears or phobias, or any medical conditions that affect their behaviour?Is there any other relevant information/specific requirements(s) that need to be known? (eg. travel sickness, mobility requirements)To the best of your knowledge, has your child been in contact with any contagious or infectious diseases or suffered from anything in the last few weeks that may be contagious?Please complete full details as to how your child will travel to and from the pickup point, including name and contact details of person(s) responsible for transportation/dropoff/collection. If relevant, include details of transportation during the trip:Statement of Consent (please write your name and date) *I give express consent to my child, as named above, participating in the activities detailed in this form