Parent / Carer Details

First name

Last name

Email

Phone

Address

Child's Details

Full Name

Preferred Name / Pronouns

Date of Birth

Day

Month

Year

School / Setting (if applicable)

Diagnosis / Needs

Any triggers / strategies to be aware of?

Medical & Additional Information

Medical Conditions / Allergies

Medications (if applicable)

Dietary Requirements

Personal Care Needs

Any other support needs we should know about?

Permissions

My child can be photographed for internal and promotional use

My child may take part in outdoor cooking, bushcraft, and supervised tool use

I give consent for first aid to be administered if necessary

I confirm I have read and understood the session information on the website

Sessions (tick all that apply)

Monday 16/02/26

Morning 9:30 - 12£40

Afternoon 13:00 - 15:30£40

Full Day 9:30 - 15:30£60

Parent & Child Morning 9:30 - 12£35

Parent & Child Afternoon 13:00 - 15:30£35

Parent & Child Full Day 9:30 - 15:30£50

Tuesday 17/02/26

Morning 9:30 - 12£40

Afternoon 13:00 - 15:30£40

Full Day 9:30 - 15:30£60

Parent & Child Morning 9:30 - 12£35

Parent & Child Afternoon 13:00 - 15:30£35

Parent & Child Full Day 9:30 - 15:30£50

Wednesday 18/02/26

Morning 9:30 - 12£40

Afternoon 13:00 - 15:30£40

Full Day 9:30 - 15:30£60

Parent & Child Morning 9:30 - 12£35

Parent & Child Afternoon 13:00 - 15:30£35

Parent & Child Full Day 9:30 - 15:30£50

Thursday 19/02/26

Morning 9:30 - 12£40

Afternoon 13:00 - 15:30£40

Full Day 9:30 - 15:30£60

Parent & Child Morning 9:30 - 12£35

Parent & Child Afternoon 13:00 - 15:30£35

Parent & Child Full Day 9:30 - 15:30£50

Friday 20/02/26

Morning 9:30 - 12£40

Afternoon 13:00 - 15:30£40

Full Day 9:30 - 15:30£60

Parent & Child Morning 9:30 - 12£35

Parent & Child Afternoon 13:00 - 15:30£35

Parent & Child Full Day 9:30 - 15:30£50

Empowering Growth Through Inclusion

Parent / Carer Details

Child's Details

Medical & Additional Information

Permissions

Sessions (tick all that apply)