Wufoo

Sibling application form

This form is to be completed by all siblings of children with a life limiting condition applying to come on a Camp Quality UK holiday. On this form "the child" is the sibling. If you would like to apply for more than one sibling you'll need to fill this form in for each additional sibling.

Child's details (1 of 5)

Child's name, contact details and date of birth
Child's name * First Last
Sibling of.... * First Last
The name of the "child with cancer"
Address line 1 *
Address line 2
City (postal town) *
Postcode *
Telephone number *

We will use this as your main number (this is normally the house phone number)
Email address for either parent

or guardian
Date of birth * DD / MM / YYYY
Example: If you were born on 1st March 1990 enter: 01/03/1990
Sex *
Male Female
Which camp has the child with a potential life limiting condition applied for?
Madam Tussauds & The London Eye 28th November 2008 - Family Day Trip New Barn 1st-3rd August 2009 (5-11yrs) Alton Towers 16th August 2009 (12+yrs) Low Mill 4th-6th September 2009 (11-14yrs) York Dungeons 24th October 2009 (12+yrs) Overstrand 6th-8th November 2009 (14-16yrs)
Social considerations (3 of 5)

We'd like a fuller picture of your child to enable us to serve them better
How has your child been coping with their sibling's illness and all it's effects?
Is there anything else we need to know?

ie, has the child been bullied?
What is the child's shirt/chest size (in inches)? Please enter a number only

They may be given a poloshirt or tee shirt for the camp
A little more info (4 of 5)

About the child and Camp Quality
Please explain why you believe the sibling should come on the holiday with the "child with his/her illness"
Please list any previous Camp Quality holidays that your child has attended
The legal stuff (5 of 5)

Please read the following very carefully
I agree to my child’s attendance at Camp Quality UK holiday(s), and to his/her taking part in the activities, travel and excursions arranged in connection with these holidays.
I agree to my child's details being used to process their application and ensure their care on holiday.
I agree that Camp Quality UK may speak to relevant agencies and professional to process my child's application and ensure their safety and medical care. *
I agree
Photographs taken during Camp Quality holidays and evaluation forms filled in following camp by children and parents are occasionally used for publicity and promotional purposes for Camp Quality UK. Are you happy for your child’s photo or evaluation forms used in this way? (Please note, we will not release your child's contact details.) *
Yes No
Do Not Fill This Out

Wufoo

Sibling application form

Child's details (1 of 5)

Social considerations (3 of 5)

A little more info (4 of 5)

The legal stuff (5 of 5)