Foxes sibling £150

First Name:

Last Name:

E-Mail:

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Street:

City:

State or province:

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How old will your child be by the start of the programme (Jun3rd)

Select One
7
8
9
10
11
other

Does your child have any dietary needs or allergies that we need to take into consideration? If you need more space please send us an email: artofmentoringuk@gmail.com

Does your child have any medical issues that you would like us to be aware of? If you need more space please email us: artofmentoringuk@gmail.com to give full details.

Please select any of the following illnesses or conditions your child may have had
asthma
diabetes
epilepsy
heart conditions
allergies
none of the above

Or any physical limitations? If you need more space please email us: artofmentoringuk@gmail.com

Do you consent to your child receiving any necessary emergency medical treatment for any injury or illness during the Art of Mentoring Week 2012

Select One
I DO consent
I do NOT consent

Captured in a few words - what is your child excited or passionate about in the natural world

Are you happy for us to use photos that your child appears in taken during the week on our website or other publicity? These can be really helpful in helping convey what the week entails to others and may be used to aid us obtaining funding.

Select One
yes
no

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