Nature Day Application - Friends of Abbey Fields

Please complete and submit this form to apply for a place at our Nature Afternoon event in Abbey Fields, Kenilworth on Saturday, 25th May 2024.

Name of child

First

Last

Name birth needs/disabilities

Preferred name

Date of birth

Name of school

School year

The year the child is enrolled in at school, not their age!

Special educational needs/disabilities

Allergies

e.g., food, plasters, pollen, etc. Please state the source and severity of allergy.

Medication

Use of an inhaler

Use of an EpiPen

Name of parent/guardian

First

Last

Address

Primary contact (name and telephone)

Secondary contact (name and telephone)

Do you consent to photos of your child

Photos may appear in promotional material on our website, social media and in print.

Payment

I have made a bank payment to account 81330209, sort code 40-26-04, “Friends of Abbey Fields”, and used my last name as a reference.

Please confirm you have made payment of £12.00