Squeals on Wheels application request form

Child's Full Name (required)

Postal Address (required)

Date of Birth (required)

Any known allergies, medical conditions, current medication or special needs that we need to be aware of: (required)

Parent/Guardian name (required)

Relationship to Child (required)

Parent/Guardian phone number (required)

Parent/Guardian Email (required)

Alternative contact name in case of emergency during Squeals (required)

Emergency contact phone number (required)

I understand that all data is managed in accordance with GDPR 2018 and all
Squeals helpers have undergone a DBS check.

I give my consent for my child to be photographed whilst taking part in activities at Squeals and for
these photographs to be displayed within the Benefice and on the Benefice website. (required)
---YesNo

I give permission for you to retain this data for the purpose of informing me about future events. (required)
---YesNo

In submitting this form you are agreeing to the following:

I understand that whilst every care and attention will be given to my child, the United Benefice of Sileby, Cossington and Seagrave and the leaders and helpers of the event cannot accept any responsibility for personal accident or loss/ damage to personal property.

HEALTH AND SAFETY
Squeals are committed to ensuring that we provide an opportunity and facility for you to spend quality time with your child/ren.
As part of this safeguarding I confirm that I am aware that my child/ren are my responsibility whilst attending Squeals.