Please see the EKO Sleepover – Kit ListName of Child*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School currently attending*Has your child had any of the following? Asthma or Bronchitis Sight or Hearing Disabilities Heart Condition Fits, Fainting or Blackouts Severe Headaches Diabetes Allergies to any known Drugs Any of allergies, e.g. food, material, dust, pollen, plasters Other illness or disability Tetanus vaccination in the last five years Does your child have any fears or conditions which may affect their enjoyment of the woodland environment? (i.e response to cold/heat, spiders, getting dirty etc.)If yes to any of the above or any other information including special dietary, cultural or other needs please specify belowConfirmationI know of no medical reason why my child should not participate.*YesNoIn the event of a minor accident and when I cannot be contacted, I agree for First Aid to be administered by a qualified First Aider.*YesNoI give my consent for photographs of my child to be used for EKO communications incl. internet site & facebook*YesNoI wish to be kept informed of other EKO activities and events.*YesNoName of Parent/Carer*Contact Number*As the parent/guardian I have read, fully understand and am satisfied with the details supplied regarding the EKO Sleepover activities and agree for my child to take part in them.*Ticking 'Signed' means you have electronically signed for this. SignedHow did you hear about the EKO 24hr Sleepover at Pigg's PlaybarnWebsiteFacebookWord of MouthSearch EngineLeafletOtherNext of kin contact detailsFor the duration of EKO sleepoverName*Email Address*Emergency Phone Number*Billing InformationPlease enter your billing informationFirst Name*Last Name*Email*Address*Address 2Town/City*County*Postcode*Country*Product NameTotal Cost of Sleepover £ 0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.