Merton Mencap's Movers and Makers Camp

Merton Mencap's data protection policy and privacy statement can be found on our website www.mertonmencap.com

Survey Monkey complies with European data protection legislation and ensures full encryption of data in line with industry standards. Some data may be stored in outside the EU under specific data agreements that ensure continued compliance with EU legislation including GDPR. However, if you prefer not to use a cloud-based system to provide sensitive data about your child and wish to register your child by telephone, our staff will be happy to help. All information you provide will be held securely on Merton Mencap's systems and shared only with staff who are contracted do deliver the Merton Mencap's Movers & Makers holiday camps. Please contact us 020 8687 4651.

Which dates do you wish your child to attend the camp?

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* 1. Which dates do you wish your child to attend the camp?

Your name (first name, surname)

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* 2. Your name (first name, surname)

Your email address

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* 3. Your email address

Your main contact number or numbers

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* 4. Your main contact number or numbers

Emergency contact name (different from the one above)

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* 5. Emergency contact name (different from the one above)

Emergency contact number

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* 6. Emergency contact number

Your child's name (first name, surname)
(If you wish to book for more than one child, please fill in a separate form for each child)

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* 7. Your child's name (first name, surname)
(If you wish to book for more than one child, please fill in a separate form for each child)

Your child's date of birth

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* 8. Your child's date of birth

Date / Time
Your child's current school (and future school if changing in September)

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* 9. Your child's current school (and future school if changing in September)

Your home address and postcode

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* 10. Your home address and postcode

What is your child's primary diagnosis  / special need?

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* 11. What is your child's primary diagnosis  / special need?

What are your child's main difficulties?

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* 12. What are your child's main difficulties?

Does your child receive 1:1 support at school?

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* 13. Does your child receive 1:1 support at school?

Can you child attend a fun group without 1:1 support?

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* 14. Can you child attend a fun group without 1:1 support?

Does your child have a physical disability, learning disability or medical need?

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* 15. Does your child have a physical disability, learning disability or medical need?

Can your child be physically aggressive?

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* 16. Can your child be physically aggressive?

Is your child at risk of putting non-food objects into their mouth?

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* 17. Is your child at risk of putting non-food objects into their mouth?

Does your child receive any specific occupational or speech language therapy interventions at school or home which we need to be aware of?

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* 18. Does your child receive any specific occupational or speech language therapy interventions at school or home which we need to be aware of?

Please describe your child's perfect day

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* 19. Please describe your child's perfect day

Please describe your child's worst possible day

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* 20. Please describe your child's worst possible day

Does your child have a tendency to run off?

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* 21. Does your child have a tendency to run off?

Is your child likely to have difficulties separating from their parent/carer when first dropped off at the camp?

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* 22. Is your child likely to have difficulties separating from their parent/carer when first dropped off at the camp?

Does your child need encouragement to go to the toilet?

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* 23. Does your child need encouragement to go to the toilet?

Does your child have allergies or require our staff to administer any routine medication?

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* 24. Does your child have allergies or require our staff to administer any routine medication?

Do you authorise Merton Movers & Makers staff to apply sun screen to your child?

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* 25. Do you authorise Merton Movers & Makers staff to apply sun screen to your child?

Do you authorise Merton Mencap to take photos/video of your child for marketing the camp and potentially to publish on our website?
(We never give data to third parties, including photos/video, and would not publish these online except on our own website)

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* 26. Do you authorise Merton Mencap to take photos/video of your child for marketing the camp and potentially to publish on our website?
(We never give data to third parties, including photos/video, and would not publish these online except on our own website)

Do you authorise Merton Mencap to contact you occasionally with useful and relevant information e.g. about future camps, a post camp evaluation form, and our bi-annual parent newsletters?

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* 27. Do you authorise Merton Mencap to contact you occasionally with useful and relevant information e.g. about future camps, a post camp evaluation form, and our bi-annual parent newsletters?

Please confirm that you agree to Merton Mencap retaining your data and your child's information securely for the purpose of delivering the camp safely and that our project staff will have access to your child's personal information?
(Our full data protection policy and privacy notice can be found on our website)

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* 28. Please confirm that you agree to Merton Mencap retaining your data and your child's information securely for the purpose of delivering the camp safely and that our project staff will have access to your child's personal information?
(Our full data protection policy and privacy notice can be found on our website)

Please tell us how you intend to pay for the camp?

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* 29. Please tell us how you intend to pay for the camp?

Please tell us if there is anything else that you think we need to know?

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* 30. Please tell us if there is anything else that you think we need to know?

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