Date Date Tuesday 15th June Wednesday 10th November

Name

Email Address*

Mobile phone number

Name of school/ setting/ company

What is your position?

Do you have any disabilities, medical or learning needs that we need to know about? Do you have any disabilities, medical or learning needs that we need to know about? Yes No

If yes, please provide details

Please provide a name and contact phone number for your next of kin

During training Charlotte regularly takes photos of adults engaging in different activities. These may be used for marketing and publicity purposes (e.g. on flyers, Facebook and on her website). Do you give consent for photos to be taken of you for these purposes? During training Charlotte regularly takes photos of adults engaging in different activities. These may be used for marketing and publicity purposes (e.g. on flyers, Facebook and on her website). Do you give consent for photos to be taken of you for these purposes? Yes No

*We may contact you via email to let you know about future events and activities that might be of interest at Charlotte’s Wood. We won’t pass your email address or any other details on to anyone else. Do you give consent for us to contact you in the future? *We may contact you via email to let you know about future events and activities that might be of interest at Charlotte’s Wood. We won’t pass your email address or any other details on to anyone else. Do you give consent for us to contact you in the future? Yes No

Any cancellations made less than 24 hours before the start of the course will incur the full course fees. Do you agree to these booking terms? Any cancellations made less than 24 hours before the start of the course will incur the full course fees. Do you agree to these booking terms? Yes No

Name and contact email address for invoice

Please check the boxes to indicate the 5 activities you would most like to do on the day Please check the boxes to indicate the 5 activities you would most like to do on the day tree cookies mallets butter knife mini hurdles rope bridges ladder nets star gazing chair wash stand triangles and tetrahedrons bows and arrows cordage elder jewellery dream catchers natural dyes charcoal elder and charcoal pencils

Is there anything else you would particularly like to do?