Parent's/Guardian's First Name (required)

Parent's/Guardian's Surname (required)

I confirm that I am the parent / guardian of the child detailed below, and I give my consent for her to attend the Girls Can project.

Child's First Name(s) (required)

Child's Surname (required)

Child's address (required)

Child's Postcode (required)

Child's Email Address (required)

Child's Mobile Phone Number (required)

Child's Date of Birth (required)

Child's School (required)

Child's Current or Upcoming School Year (required)

Please give details of someone we could contact if there were an emergency while your child is at a Girls Can session:

Emergency contact name (required)

Emergency contact relationship to child (required)

Emergency contact phone number (required)

Please provide the following health information so that we can keep your child safe:

Does your child have any health conditions we should know about? If yes, please state below. (required)

Is your child currently taking any medication? If yes, please state below. (required)

Does your child have any allergies? If yes, please state below. (required)

Does your child have any access requirements (e.g. wheelchair access)? If yes, please state below. (required)

I give my permission for the child detailed above to be photographed and filmed for publicity purposes. I understand these images may be used on Kainé social media, the Kainé website or printed materials.

Child's skills and interests: Please identify any skills or interests your child has which could be incorporated into the Girls Can programme.

I DO NOT wish to be updated with Kainé events and promotions.

I DO NOT wish to be added to any Kainé WhatsApp groups.