Outwood: Rooks Nest Academy – Tue 14th & Wed 15th Feb 10am – 3pm

Child First Name: *

Child Last Name: *

D.O.B: *

Age Group: * Under 6 Under 7 Under 8 Under 9 Under 10 Under 11 Under 12 Under 13

Name of School: *

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Please indicate if your child has any allergies: * Yes No

Please indicate if there are any medical conditions: * Yes No

Type of Medical Condition (optional):

Phone number: *

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I give permission for my child to be included in any photographs and films: * Yes No