SIGN UP FORM

Please complete and submit the Sign Up form below.

If you have any questions please get in touch

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1. Referrer's and Child's Details:

Referrer's name

Referrer's contact number

Referrer's email address

Referrer's/organisation's address

Referrer's relationship to child

I am 16 years old or over and am making a self referral

Yes

Childs/ young person's name:

Child/ young person's date of birth

Child's/ young person's address

2.Parents/Carers details (if not the person completing this form)

Parent/Carer name:

Parent/Carer Contact number

Parent/carer Address

3. Named contact and Telephone number in case of emergency:

4. Reasons for signing up (Select top 3)

1.

2.

3. 5. Additional Information

Does the child or young person have any allergies, including food allergies or pre-existing medical conditions that we should be aware of - please detail below;

Risk Assessment - Is there anything specific that we should be aware of that could present a risk to this child/young person or would they present a risk to others working in a group or 1:1 session;

Please state any other information that you think would be relevant;

During participation in sessions photographs may be taken and we would like your permission to use any photographs in the following ways: in CYP Gardening Project publications e.g. Annual report, website, promotional material e.g. leaflets and at events to promote the work of the project and our social media accounts e.g. Facebook, Twitter and Instagram. We would also like to build an album for the children & young people to keep when they finish attending.

6. Photograph consent

Please select option below

I give consent for photographs to be taken and used as described above

I give consent for photographs to taken for their own album only

I DO NOT give consent for any photographs to be taken of my child

I give consent for photographs to be taken but would like to discuss further re: specific conditions e.g. photos can be used for publications but do not show my childs face (Please state in box below)

7. Referrer's Signature

Thanks for submitting.

You will be responded to within 48 hours

"The glory of gardening: hands in the dirt, head in the sun, heart with nature. To nurture a garden is to feed not just the body, but the soul."

- Alfred Austin

"We may think we are nurturing our garden, but of course it's our garden that is really nurturing us."

- Jenny Uglow.

SIGN UP FORM

Please complete and submit the Sign Up form below.

If you have any questions please get in touch

1. Referrer's and Child's Details:

Referrer's name

Referrer's contact number

Referrer's email address

Referrer's/organisation's address

Referrer's relationship to child

Childs/ young person's name:

Child/ young person's date of birth

Child's/ young person's address

2.Parents/Carers details (if not the person completing this form)

Parent/Carer name:

Parent/Carer Contact number

Parent/carer Address

3. Named contact and Telephone number in case of emergency:

4. Reasons for signing up (Select top 3)

1.

2.

3.

5. Additional Information

Does the child or young person have any allergies, including food allergies or pre-existing medical conditions that we should be aware of - please detail below;

Risk Assessment - Is there anything specific that we should be aware of that could present a risk to this child/young person or would they present a risk to others working in a group or 1:1 session;

Please state any other information that you think would be relevant;

6. Photograph consent

7. Referrer's Signature

SIGN UP FORM

Please complete and submit the Sign Up form below.

If you have any questions please get in touch

1. Referrer's and Child's Details:

Referrer's name

Referrer's contact number

Referrer's email address

Referrer's/organisation's address

Referrer's relationship to child

Childs/ young person's name:

Child/ young person's date of birth

Child's/ young person's address

2.Parents/Carers details (if not the person completing this form)

Parent/Carer name:

Parent/Carer Contact number

Parent/carer Address

3. Named contact and Telephone number in case of emergency:

4. Reasons for signing up (Select top 3)

1.

2.

3.

5. Additional Information

Does the child or young person have any allergies, including food allergies or pre-existing medical conditions that we should be aware of - please detail below;

Risk Assessment - Is there anything specific that we should be aware of that could present a risk to this child/young person or would they present a risk to others working in a group or 1:1 session;

Please state any other information that you think would be relevant;

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6. Photograph consent

7. Referrer's Signature