***Official sensitive***

Team booking form for Let’s Get Active CiCC Activity and Consultation days 25th 26th and 27th July at Danbury Outdoors. All forms must be returned by 14th July. No Bookings will be accepted after this date.

Day Group Attending
(please circle) / 25th July 8 – 12 yrs old / 26th July 12 – 17 yr olds / 27th July CP/CIN
Group Leader: / Contact no: / Email
Quadrant & Team: / Team Manager
Number of children/young people in group / Age range of group
Do members of your group have any access/dietary needs? / Yes / No / Number of staff attending the event with group:

Parental Consent

By completing this group application form you are taking responsibility to obtain parental consent for the children and young people in your group to attend the South and West Quadrant Activity and Consultation day on the days above at Danbury Outdoors. You must also be in receipt of any emergency and medical details that may be required in the event of an accident/emergency.

The days will include outdoor and creative activities, workshops and consultation activities which may be documented in a variety of ways to record children and young people’s views and achievements, including photography, film, voice recording and the taking of quotes. Please ensure you have obtained appropriate consent for these and included the information on the following form so we can be clear as how each individual participant is able to participate.

I confirm I have parental consent for the children/young people listed to attend Let’s Get Active Consultation and Activity day at Danbury Outdoors.

Signed:…………………………………………………………… Date:………………

Group Leader………………………………………… Service Area/Team……………………………. Contact number………………………………………………

Consent / Access Requirements
Name / Age / DOB / Parental / Photo / face paint / Film / Voice / Quotes / Disability/medical information / Access requirements / Dietary requirements
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Group Monitoring Information In order to ensure the children and young people from a broad range of backgrounds, abilities and ages are being given the opportunity to take part in ‘Lets Get Active’ we need to collect the following data. Please tell us how many of your group:

Male / Female
Looked after / Young offenders / Young parents
Care leavers / Young asylum seekers / Not in education, employment or training
Have a learning disability / Have a physical disability
Live in Foster care / Live out of Essex / Live independently
Live in a residential home / In supported accommodation / Live in Kinship care
White British / Black British / Pakistani Asian
White Irish / Black Caribbean / Bangladeshi Asian
Traveller of Irish Heritage / Black African / Chinese
Romany / British Asian / Mixed heritage
Gypsy / Indian Asian / Another ethnicity (Please give details)

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Please Return to by 14th July. No Bookings will be taken after this date.