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About us
Support for families
Get involved
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Make a referral

Children’s Residential Needs Form

To ensure we can best support your family, please complete the below form, as soon as possible.

Details of the Child Attending

First name(Required)

Last name(Required)

Date of Birth*(Required)

Day

Month

Year

Gender*(Required)

Details of Parent/Guardian

First name(Required)

Last name(Required)

Relationship to Child(Required)

Phone number(Required)

Address(Required)

Emergency Contact

First name(Required)

Last name(Required)

Contact number(Required)

Relationship to Child(Required)

Address(Required)

Do you wish to add another emergency contact?*(Required)

Yes

No

First name(Required)

Last name(Required)

Contact number(Required)

Relationship to Child(Required)

Address(Required)

Medical Information

Name of GP(Required)

GP phone number

GP address(Required)

Does your child have a disability that Once Upon a Smile should know about?(Required)

Yes

No

Please provide details of the disability including any help that your child may need.

Does your child suffer from any medical conditions?(Required)

Yes

No

Please provide details of the medical condition and any medication required.

Does your child have any allergies?(Required)

Yes

No

Please provide details of the type of allergy medication.

Please advise of any dietary requirements (if none, put N/A).*(Required)

Additional Information

What activities does your child enjoy / not enjoy?*(Required)

For us to ensure your child's stay at The Adventure Farm Trust is as comfortable as possible, please identify any care needs e.g.; bedwetting, washing, dressing and feeding skills.*(Required)

Are there any reasons why your child may become distressed, have challenging behaviour, triggers or phobias? It would be useful to know what steps to take in these situations.*(Required)

Would you like to share any further information?

Terms & Conditions

At Once Upon a Smile, we love to share the amazing work our children take part in. Do you agree for your child to participate in photography & videography? This can include the possibility of sharing on our social media platforms.(Required)

Yes, I agree

No, I do not agree

Declaration(Required)

I agree to the names above being kept on database for tracking and contact purposes. I agree that Once Upon a Smile can share information with other organisations working with myself and my child including education and health.(Required)

Declaration(Required)

By clicking this declaration I agree to my child attending The children’s Adventure Farm residential trip and confirm I have the relevant authority to consent.(Required)

Declaration(Required)

I confirm that I will be available for the duration of the Residential should OUAS need to contact me and/or if I need to collect my child/ren at short notice from The Children’s Adventure Farm.(Required)

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