Registration form – Stonožka

    Parent's/ Carer's Surname:
    First Name:
    Home address (including postcode):
    Contact telephone number:
    Email:

    1. Name of Child: Date of birth:
    2. Name of Child: Date of birth:
    3. Name of Child: Date of birth:

    Any health problems/ allergies?
    Any medication?

    Communication in Czech/ Slovak language:
    Any other information about your child/ children you want us to know, e.g. what they do not like, what they are scared of, cannot speak in Czech/ Slovak but understand very well, etc.

    Are you interested in supporting/ volunteering for Stonožka and CS Community and School Bristol CIC? How could you help? (Please let us know what are your qualifications, skills, etc.)

    Emergency Contact Details:

    Contact 1

    Contact Name
    Relationship
    Telephone number

    Contact 2

    Contact Name
    Relationship
    Telephone number

    Consent of child´s/ children´s parent or primary carer:
    GDPR. I give permission Czech & Slovak Community and School Bristol CIC to keep the above personal records in accordance with the Data Protection Act 2018 for the period of your child/children attending Stonozka Centre? yesno
    To comply with the Data Protection Act 2018, we need your permission before we can take any photographs or make any recordings of your child/ children for promotional purposes.
    May we take photographs or videos of your child and use them (unidentified by their full name) for promotional purposes? yesno
    May we use your child´s images on our website, Facebook, Instagram and Twitter? yesno

    Parent´s or carer´s signature:
    Date: