Little Alchemist

Child's First name

Child's Last name

Birthday

Day

Month

Year

Parent/Guardian Name & Relationship to Child

Phone

How would you describe your child’s personality?

What are some things they especially enjoy or are interested in?

Is there anything your child currently finds difficult or feels sensitive about?

Are there particular situations that can make them feel anxious, frustrated, sad, overwhelmed or uncomfortable?

Are there any changes or circumstances at home or school that may currently be affecting them and that would be helpful for us to understand?

Is your child comfortable participating in a group, or do they sometimes need a little extra time or encouragement before joining?

Does your child have any allergies, food intolerances, dietary requirements or foods they may not eat?

Does your child have a medical condition, previous injury or other health-related need that we should know about?

Does your child carry or require emergency medication, such as an inhaler or (allergy) medication? If yes, please explain exactly when and how it should be used.

Has your child been unwell recently, or is there anything regarding their health that we should currently monitor?

Does your child need any support with bathroom use, changing clothes or other personal care during the day?

Who may collect your child at the end of the day? Please provide their full name and relationship to the child.

Please provide a second emergency contact in case we cannot reach you. Include their full name, relationship to the child and telephone number.

Emergency permission

In the unlikely event that your child becomes unwell or has an accident, we will contact you or the emergency contact as quickly as possible. If urgent medical assistance is required, we will provide appropriate first aid and contact the emergency services.

Please confirm:

“I give permission for the Little Alchemists facilitators to provide basic first aid and to contact emergency medical services when reasonably necessary for my child’s safety.”

Photographs

We may occasionally take a few photographs during the creative activities.

Please indicate your preference:

Photographs or videos of my child may be used on Alchemia’s social media or promotional materials.

Photographs or videos may be used, but my child’s face must not be visible or identifiable.

Please do not photograph or film my child.

Finally, is there anything else—big or small—that would help us understand, support or care for your child during the day?

Please do not bring your child if they have a fever, have vomited, have diarrhoea, appear contagious or feel too unwell to participate comfortably in the day. Please let us know as soon as possible if they become unwell before arrival.

By signing below, I confirm that the information provided is complete and accurate, and that I will inform Alchemia if anything relevant changes before the activity.

Signature of legal parent

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