Graffiti Workshop (Thursday 30th May)

Details of young person

Young person's full name

Young person's date of birth (DD/MM/YYYY)

Please note, we can only offer spaces to people aged 11-17 years

Does the young person have any allergies?

Yes

No

If yes, please give details of any allergies

Details of young person's dietary requirements

This is because we may offer snacks and drinks during the workshop

Please state if the young person is on any medication

Please include medication such as asthma inhalers, antihistamines or anything else that may affect their participation in the workshop

Is there any other information that you wish for staff to be aware of?

Such as learning needs, disabilities, physical or emotional needs

Parent/carer/guardian consent

Parent/carer/guardian full name

What is the relationship to the young person?

Parent/carer/guardian contact number

We will use this to keep you updated about the workshop

Parent/carer/guardian email address

We will use this to keep you updated about the workshop

Emergency contact number

Please provide a contact number for us to call in the event of an emergency

Additional information

How would you like us to contact you?

Email

Phone call

Text message

All of the above

In order to confirm the young person's place on the workshop, we will be in touch using your chosen method of communication

How will the young person be getting to/from the workshop?

Will they getting picked up/dropped off, or will they be travelling independently

Data Protection

Please be aware that the information you have provided will be stored securely and retained at least until 31st December 2026, in compliance with Data Protection Act 2018.
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Graffiti Workshop (Thursday 30th May)

Details of young person

Additional information

Data Protection

Montgomeryshire Wildlife Trust