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Your Waiver / Intake Form

Each participant must complete a waiver form prior to their activity. If you are filling out this form for a family activity or for multiple siblings, please contact us for extra copies of this form. You will need to fill out one form for each participatnt. If you've already filled out a form for a previous activity with cheekymono, please let us know, you should only need to do this once a year, thank you.

Personal details

Childs preferred first name

Childs last name

Parent/Guardians full name

Parent Email

Parent Mobile Phone

Emergency contact details

If your child becomes ill and must be picked up, who should I contact?

My emergency contact details are; (please give your name and mobile number)

My backup emergency contact details are; (name and mobile)

Allergies, Medications & Medical Needs

Does your child have any known allergies? (Asthma, Hay Fever, Insect Bites, Medicines, Etc.)

Does your child have any allergies and/or reactions to food?

Are any medicines given regularly (what and when is it given)?

Are there any special medical concerns or additional needs I should know about?

Medical Treatment

I/we give permission for a plaster to be administered to my child’s skin should the need should arise.

I/we understand that should my child require emergency medical advice or treatment in the event of an incident, Sara Wright will do everything possible to contact me. Should this not be possible;

I/we give consent to the seeking of any emergency medical advice or treatment

Marketing

How did you hear about us?

Photographs I/we give consent to my child being photographed by Sara Wright

Social Media I/we give permission for my childs' photo to be used on cheekymonos' digital or print marketing

Parent/Guardian Declaration and Consent

I confirm that I am the parent or legal guardian of the child named on this form and give permission for them to participate in activities provided by Cheekymono.

I understand that physical activity involves some inherent risk of injury. I confirm that, to the best of my knowledge, my child is fit to participate and that I have disclosed any relevant medical conditions or additional needs.

I understand that Cheekymono will take reasonable care to provide a safe and supervised environment. I consent to staff administering basic first aid and seeking emergency medical treatment if necessary.

Signature

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Date

Day

Month

Year

Please keep me up to date with any changes that may occur or if there is anything that you would like me to include or exclude. My aim is to make your families time at cheekymono as happy and stress free as possible for all parties involved. Thank you