Please print then complete the following form to give permission for your young person to attend the activity described.
Then return it together with any payment to Akela by ??????.
| Name of young person | |||
|---|---|---|---|
| Venue | Enter the name of the event venue here | Date | Enter the date of the event |
| Please state if the named young person has a disablity or condition which might be affected by this activity (hayfever, travel sickness, food, allergies, asthma, etc.) |
|||
| Please give details of any medical treatment he/she is having at the moment | |||
| Contact Numbers (please provide two) |
Mobile | ||
| I enclose the cost of the activity | ££££££ | Cash [ ] Cheque [ ] (Please tick) | |
| The young person will be collected by | |||
| I give permission for the named young person to attend | |||
| Signed | Date | ||
| Relationship to young person | |||