Statement Of Fitness &

Video Consent Form

Childs First Name

Childs Last Name

Birth Date required

Medical Information

Adults Full Name

Emergency Contact Number

Date required

Signed

Please Confirm Required

I confirm that all medical conditions and/or allergies have been declared, and that the appropriate medication is carried by the child at all times.

I confirm that my child is fit to participate in the show, and I will notify the teacher of any changes to health before 25th July.

I agree to teachers and chaperones administering first aid to my child if needed.

I consent to my child being videoed during the perfomance, and for their name to be published in the show programme.

Thanks for submitting!