First name *
Middle name(s)
Last name *
Gender
 Male Female
Date of birth *

Primary school *
---Ashley Primary SchoolBiddick Hall Junior SchoolCleadon Church of England SchoolForest View Primary SchoolHadrian PrimaryHarton Primary schoolHome SchooledMarine Park Primary SchoolMarsden Primary SchoolMortimer Primary SchoolRidgeway Primary SchoolSea View Primary SchoolSt Bede’s RC VA Primary SchoolSt Gregory’s RC Primary SchoolSt Oswald’s RC VA Primary SchoolStanhope Primary SchoolWestoe Crown Primary School
Primary school
Home address
Address line 1 *
Address line 2
Town/City *
County
Postcode *

First name *
Middle name(s)
Last name *
Relationship to child
Address line 1 *
Address line 2
Town/City *
County
Postcode *
Contact mobile no.
Contact home no.
Email

First name *
Middle name(s)
Last name *
Mobile no.
Home no.
Email
Relationship to child

Please read the following information. If your child has a medical condition, please also complete the relevant sections below. For the duration of the Summer School, we will have staff who are first aid qualified, and are experienced in looking after the welfare of students. To do this effectively, we would ask for your assistance to:
- Advise us of any medical conditions, including allergies.
- Let us know when there are any changes to your child’s health / conditions.
- Ensure we always have up to date contact details for you, in the case of an emergency.

Declaration - I have read the Medical welfare information.
 Yes No

Managing medication

Should your child’s condition require them to be medicated whilst at the Summer School, our policy is to only accept medication from parents and carers. This enables staff to correctly administer medication. Our medical care policy (available on the Academy website) has more detail.

 I agree My child does need medication but I cannot attend my child does not need medication during the school day

Asthma / Allergies

If your child is prescribed an inhaler or auto-injector (e.g. epi-pen / jext pen) we would encourage your child to carry these devices. Spare devices can be stored in school but must be delivered by you to school.  I agree my child does not require an inhaler or auto-injector

Please outline any medical conditions/allergies your child has.

What medication has your child been prescribed for the conditions you have reported?

Please note - we can only accept medication for administration by staff, which has been prescribed by a medical practitioner. We will require an initial meeting with you to do this. It remains your responsibility to ensure your child has sufficient medication in school, and that it is in date. See our medical care policy for further details.
Please outline any food allergies/specific dietary requirements:

We may take photographs of activities during Summer School. These can be of individuals, groups, activities and events. Do you give your consent to:

 Take photograph (other than for identification). Use the photo on posters, displays and presentations in the Academy. Use pictures on newsletters, brochures and our prospectus. Post the picture on Academy website. Use the image on social media. This includes Facebook, Instagram and Twitter. Include photographs in the end of school yearbook. Decline (Declining to give consent may only mean your child is blurred out ).

We may record images of participants. I give my consent to:

 Video images being taken, stored and views on the Academy’s secure learning platform. Video images being taken on line. We use Vimeo and YouTube. Video images being shared with employees and governors/directors of the Academy. Decline (Declining to give consent may only mean your child is blurred out).

I give permission for my child to take part in the following activities:

 Using the internet in line with the Academy’s acceptable usage. View films/video clips that are appropriate. Take part in art work and technology workshops Take part in food preparation/cooking activities. Take part in varied sporting activities. Take part in drama workshops. Take part in local/regional outings.

Activity Selection

Pupils will be given the opportunity to participate in paddle boarding/surfing, foot golf, or an escape room. We will try our best to give pupils their first choice, but we can’t guarantee it.

 Paddle boarding/Surfing. Escape Room. Foot Golf.

Water Activity

We have arranged for pupils to participate in a variety of activities.
I consent to my child taking part in this activity.
 Yes No

Is your child water-confident?
 Yes No

Can your child swim?
 Yes No

Size of T Shirt
 S - Youth Size 6-7 M - Youth Size 8-10 L - Youth Size 12-14 XL - Youth Size 16-18

We will be holding a celebration at the end of both weeks. This will be a great opportunity for pupils to share their experiences. Due to current restrictions, we can allow a maximum of 2 guests per child.
 I am unable to attend I can attend

I give permission for my child to walk home unaccompanied at the end of each day.
 Yes No

I agree that if my child consistently misbehaves, is uncooperative, endangers others by not following instructions that I will be contacted and must collect my child from school immediately. I understand that the Academy will decide if they are able to return to Summer School.
 Yes No

I give permission for the school to contact me via: phone/email/text.
 Yes No