Get in touch

Please drop us a line using the form opposite or ring us on 01872 885779 

Name *
Name

Park Farm
Truro
TR1 1SX

+44 (0) 1872 885779

Inspiring and educating children about sustainability and the natural environment through exciting hands-on experiences including school camp, summer camp, workshops and forest school. Based in Cornwall, our focus is green education, and our mission is to reconnect and engage children with the natural world, inspiring them to live more sustainably. 

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Medical dietary and consent form

Summer camp Medical, dietary and consent form 2019

Please complete and submit the form below at least two weeks before camp commences.  

Contact details
Parent/Guardian Name 1 *
Parent/Guardian Name 1
Please include dialling code if outside the UK
Parent/Guardian Name 2 *
Parent/Guardian Name 2
Please include dialling code if outside the UK
Your child/ren
Child 1 date of birth *
Child 1 date of birth
Please provide details of relevant medical history, medical conditions and any medication which your child will require during camp.
Please provide details of any dietary requirements we should be aware of.
Child 2 date of birth
Child 2 date of birth
Please provide details of relevant medical history, medical conditions and any medication which your child will require during camp.
Please provide details of any dietary requirements we should be aware of.
Child 3 date of birth
Child 3 date of birth
Please provide details of relevant medical history, medical conditions and any medication which your child will require during camp.
Please provide details of any dietary requirements we should be aware of.
Permissions
Consent to take part in activities *
Please check the box below to confirm you understand that the activities to be undertaken involve an element of risk (which is managed according to the risk assessment available on request) and you accept them as part of each activity's enjoyment.
Consent to emergency medical treatment *
Camp Kernow will contact you before the commencement of any medical treatment, unless your child's condition is such that immediate treatment is required before contact with you can be made. Please check the box below to confirm you authorise Camp Kernow to consent to any X-ray, examination, anaesthetic, diagnosis, treatment, and/or hospital care that may be recommended for your child/ren by a licensed physician or dentist.
Consent to administer medication *
Please check the box below to confirm your authorisation of Camp Kernow staff to administer first aid and (where applicable) your child/ren's prescription medication as prescribed by a physician.
Photo & filming permissions
Please advise if you consent to photos of your child/ren being displayed on Camp Kernow's website and accompanying press releases issued by Camp Kernow which could result in a photo of your child/ren being used by a newspaper or magazine either online or in print.
Please advise if you consent to photos/video of your child/ren being displayed on Camp Kernow's social media (Instagram/Twitter & Facebook). NB names are never published.
During your child/ren's time at camp we may have a student photographer documenting life at camp. Please indicate if you would be happy for your child/ren's photo to be displayed in their portfolio of work.
During your child/ren's time at camp a guest chef may be delivering cookery sessions. Please indicate if you are happy for your child/ren's photo and/orfootage of your child/ren to be featured on their social media.
Please let us know if your child/ren is/are coming with a friend/s and would like to be in the same accommodation structure (please note accommodation structures are single sex).
Please use this box to share with us any further information you think may be relevant for us to know in order to ensure your child/ren are fully supported during their time here at camp. Please include details of any behavioural issues we should be aware of.
I certify that the above information is correct to the best of my knowledge
Please type your name in full and check the box below to confirm.
*