Release Form

wicked release form Child’s Name: ................................................................................................................................................




I agree to my child going to see Wicked on Tuesday 09 December 2008

I hereby grant permission for my child to travel to and from Apollo Victoria Theatre in London as part of The Man In The Moon group on Tuesday 09 December 2008. I understand that this is an unsupervised activity even though they will be travelling as part of a group with their peers. I understand that The Man In The Moon is not able to provide adult supervision on this outing and that my child is responsible for making travel arrangements to and from the theatre. I will make clear arrangements with my child as to where and when they will be picked up following the outing and that this is an arrangement made between myself and my child. The Man In The Moon will not be responsible for my child keeping to these arrangements. Emergency Contact Numbers for evening of the Wicked trip: 1. Name ..................................................................... Relationship to Child ................................................................ Telephone Number ................................................. Mobile Number ....................................................... 2. Name ............................................................................ Relationship to Child ....................................................... Telephone Number ................................................. Mobile Number ....................................................... Use this section to let us know any other important information that you feel we should know .................................. .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... .................................................................................................................................................................................................................... ....................................................................................................................................................................................................................




I do not agree to my child going to see Wicked on Tuesday 09 December 2008

Parent/Carers Signature: ......................................................................... Date: ........................................ The Man In The Moon : : 9 Beacon Hill Road : : HINDHEAD : : GU26 6NR Telephone / Fax: 01428 608866 : : www.themaninthemoon.co.uk