Festina Lente Children's Workshops Registration Form & Emergency/Health Information Form

This form is to be used to record the support needs of young people attending Festina Lente Walled Garden Camps and Workshops. Please provide as much information as possible to help us ensure that your son/daughter derives the maximum benefit from their time with us.

My Child is booked in:*

February Mid Term Break Camp \ Activities
Easter Camp \ Activities
Summer Camp \ Activities
Halloween Mid Term Break Camp \ Activities
Christmas Camp \ Activities
Other Camp \ Activities

Child’s First Name:*

Child's Last Name:*

Child's Age*

Child's Date of Birth*

Parent \ Guardian \ Service Worker Details which can be used for emergencies

Name of Main Emergency Contact:*

Mobile Number of Main Emergency Contact*

Relationship to Child*

In case of Emergency please list contact details of a second person who is over 18 we can contact if we are unable to contact the main contact.

In Emergency Second Contact Name*

In Emergency Second Contact Mobile Number*

In Emergency Second Contact Relationship to Child*

Mark here if you do consent that your child may be photographed by staff, and for any such photographs to be used in future Festina Lente charity publications and promotional materials.*

I consent
I don't consent

Parent’s \ Legal Guardians Signature: I attest that the child listed is in good physical and mental health. Any special considerations are indicated below.

Please type in your name in here which will be taken as a written signature from you*

Medical Information

1. Has your child been diagnosed with a medical condition/disability? Please give details below. If none, indicate "none" in the field below:*

Does your child have a difficulty in any of the following areas - please specify: A. Physical: Mobility, balance, posture. B. Sensory: Sight, sound, touch, smell, taste, vestibular (balance and the sense of movement) and/or proprioception (sense of body position in space). C. Communication (expressive and receptive): Verbal skills, listening, ability to follow instruction. D. Cognition: understanding, concentration, memory. E. Psychosocial: social interaction, self-esteem etc. If none, indicate "none" in the field below:*

3. Please outline the particular supports that your child might need in order that s/he can participate in the camp or workshop. If they get 1-to-1 support in school or have an SNA please give details.*

What allergies does your child have? Please be specific as to the severity and treatment. Please note staff cannot administer any medications. If none, indicate "none" in the field below:*

For hot weather we would ask that you apply sunscreen to the child prior to arrival at camp. Please state below if you allow staff to apply sunscreen and/or Antihistamine cream if required during the day, please note there will be two staff members present if this occurs and all our staff are Garda vetted:*

Yes
No

Is there any additional information you can provide to ensure a positive camp experience for your child?

CAMPER CODE OF CONDUCT WHICH WE ASK IS EXPLAINED TO THE CHILD PRIOR TO ARRIVAL AT FESTINA LENTE: • Campers will treat their fellow campers, instructors, staff with respect. • Campers will follow directions, health and safety messages and signs and they will stay with their group.

I have read & agree with and I have discussed this Code of Conduct with my child.*

Yes
No

Phone

This field is for validation purposes and should be left unchanged.

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Equestrian & Horticultural Education

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Festina Lente Children’s Workshops Registration Form & Emergency/Health Information Form

Parent \ Guardian \ Service Worker Details which can be used for emergencies

In case of Emergency please list contact details of a second person who is over 18 we can contact if we are unable to contact the main contact.

Parent’s \ Legal Guardians Signature: I attest that the child listed is in good physical and mental health. Any special considerations are indicated below.

Medical Information

Festina Lente

Office address

Useful Links

News Updates

About Festina Lente

Equestrian

Horticulture

Services

Events

Equestrian & Horticultural Education

learn more

Equine welfare

our horses

How you can help

GET INVOLVED

Contact us

Festina Lente Children’s Workshops Registration Form & Emergency/Health Information Form

Parent \ Guardian \ Service Worker Details which can be used for emergencies

In case of Emergency please list contact details of a second person who is over 18 we can contact if we are unable to contact the main contact.

Parent’s \ Legal Guardians Signature: I attest that the child listed is in good physical and mental health. Any special considerations are indicated below.

Medical Information

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