Parent's/ Carer's Surname: First Name: Home address (including postcode): Contact telephone number: Email: 1. Name of Child: Date of birth: 2. Name of Child: Date of birth: 3. Name of Child: Date of birth: Any health problems/ allergies? Any medication? Communication in Czech/ Slovak language: NONEAVERAGEFLUENT Any other information about your child/ children you want us to know, e.g. what they do not like, what they are scared of, cannot speak in Czech/ Slovak but understand very well, etc. Are you interested in supporting/ volunteering for Stonožka and CS Community and School Bristol CIC? How could you help? (Please let us know what are your qualifications, skills, etc.) Emergency Contact Details: Contact 1 Contact Name Relationship Telephone number Contact 2 Contact Name Relationship Telephone number Consent of child´s/ children´s parent or primary carer: GDPR. I give permission Czech & Slovak Community and School Bristol CIC to keep the above personal records in accordance with the Data Protection Act 2018 for the period of your child/children attending Stonozka Centre? yesno To comply with the Data Protection Act 2018, we need your permission before we can take any photographs or make any recordings of your child/ children for promotional purposes. May we take photographs or videos of your child and use them (unidentified by their full name) for promotional purposes? yesno May we use your child´s images on our website, Facebook, Instagram and Twitter? yesno Parent´s or carer´s signature: Date: Δ
