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Art Camp consent form 2023
Home
Learning and Creativity
Art Camp consent form 2023
Consent Details
Name
*
Date of Birth
*
Parent's Name
*
Address of Parent
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Home Telephone Number
Emergency Contact Number 1 (no spaces)
*
Emergency Contact Number 2 (no spaces)
*
Email
*
Does your child have any allergies / phobias / known reactions to art materials?
All parents/carers - please see ‘Important Information for Parents’ re our request to exclude nuts from lunchboxes.
Does your child have any additional needs (physical, learning or emotional) we should be aware of?
I consent to any emergency or non-emergency medical treatment necessary for my child/children during the workshop.
*
Yes
No
I am supplying my child with medication for them to take/administer themselves
*
Yes
No
I am supplying my child with medication and agree to a member of the Holburne staff administering it as instructed by me in writing.
*
Yes
No
I confirm that I, or a designated person, will accompany and sign in my child/children to the workshop and collect them promptly afterwards and sign them out.
*
Yes
No
I confirm my child is over the age of 6.
*
Yes
No
I agree that the Holburne cannot take responsibility for my child on their journey to and from the Museum if they intend to arrive and leave unaccompanied by me.
*
Yes
No
I agree to my child and/or their artwork being photographed or filmed for the promotion of Holburne Museum activities (e.g. website, E-newsletter, annual reviews) Please note: Children’s names will not be used
*
Yes
No
Please can you tell us how you heard about the Art Camp?
Art Camps
*
Please specify which Art Camp date(s) you are booking this child onto
Monday 24th July - Melodic Music
Tuesday 25th July - Regal Romans
Wednesday 26th July - Animal Friends
Thursday 27th July - A 3D Pop-up World
Monday 31st July - Gems, Gold and Glitter
Tuesday 1st August - Summer is here!
Wednesday 2nd August - Fake or Fortune?
Thursday 3rd August - Showtime!
Tuesday 8th August - Mini Museums
Wednesday 9th August - Potty Prints
Please specify if you would like to be added to our Families Mailing list, here you will have first notice of all upcoming events including art camps, family drop-ins and more.
Verification
Please enter any two digits
*
Example: 12
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