Free Activity Day

11 March, 2011 at 11:25 Leave a comment

Cornwall Children’s University In conjunction with Extended Services Are holding an event for

Home Educated Young People at

Porthpean Outdoor Education Centre, Castle Gotha Farm, Porthpean, St Austell,PL26 6AZ

on Wednesday 23rd of March 9.30am-4 pm

For young people aged 8 years and over

Take part in

Dance and Cheerleading Workshops

Zip Wire, Archery and Climbing Wall activities with Cornwall Outdoors

To book your place please complete the booking form below and return to Sara Bennett, Extended Services, Children Schools and Families, Dowrglann, Stennack Road, St Austell, PL25 3SW by 17th March.

Young people will need to bring a packed lunch For further information contact Sara Bennett 01726 874010

Children’s University enables young people to collect a sticker/stamp for each hour of validated activities they take part in and receive an award after 30, 65 and 100 hours of activities. Activities are available both within the county and nationally. Children’s University passports are available at the event for £1

Parental Consent Form

Data Protection act. The information being collected on this form will only be used for the purpose of Extended Services administration under Department of Education and Skills guidelines. The data will not be disclosed to any external sources other than in an emergency.

1. ACTIVITY: Porthpean Outdoor Activity Centre Wednesday 23rd March from 9.30am – 4pm

2. Name of participant:…………………………………………………………………….

3. Address:…………………………………………………………………………………………………………. …………………………………………………………………………………………………………. 4. Tel No:…………………………………

5. DOB………………………………. Age:…………………

6. Emergency address and/telephone (if different from above)……………………………………………… …………………………………………………………………………………………………………………….

Personal Information: please give details requested below or personal information which might be relevant.

A. Has your child, to your knowledge, been in contact with any infectious illness in the last three weeks? Yes No If yes please give details…………………………………………………

B. Does he/she suffer from any allergies, diabetes, migraine, epilepsy, bad period pains, sleepwalking, bed wetting or any other illness or disability? Yes No If yes please give details………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………………….

C. Is he/she allergic to anything (e.g. antibiotics, elastoplasts, aspirin or any such medicines, any particular food/drink)? Yes No If yes, please give details ……………………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………

D. Is he/she actively sensitive to penicillin? Yes No If yes, please give details……………………. …………………………………………………………………………………………………………………….

E. Is he/she receiving any medical treatment at present? Yes No If yes, please give details…………………………………………………………………………………………………………..

F. Date of last anti-tetanus injection:………………………………………………….

G. Does he/she have any special dietary needs?………………………………………………………………………

……………………………………………………………………………………………………………………. H. Can he/she swim 50 metres? Yes No

I. Name & address of own Doctor:……………………………………………………………………………. …………………………………………………………………Tel No………………………………………….

J. I consent to my child being photographed participating in the activity day. The photographs may be used to publicise the event by Extended Services or the local press Yes No

Insurance: Cornwall County Council and Activity Providers public liability insurance PARENTAL CONSENT: (i) I have read the information provided and agree to my son/daughter taking part in the above activities. (ii) I acknowledge the need for him/her to behave responsibly at all times. (iii) I understand that the staff responsible for the activities will take all reasonable care of participants. (iv) I consent to any emergency treatment if necessary. I therefore authorise the party leader(s) to sign, on my behalf, any written form of consent required by the hospital authorities should medical treatment (a surgical operation or injection) be deemed necessary, provided that the delay required to obtain my signature might be considered, in the opinion of the doctor or surgeon concerned, likely to endanger my child’s health or safety.

Signature: Print Date:

Porthpean Activity Day 23 3 11.pdf

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Mid Cornwall Home Ed Group – Thursday events Bodmin and St Austell Home- Ed Group

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