Wellbeing Days Booking form

Which session would you like to attend?

Lead adult's full name

First

Last

Email address

Mobile telephone number

Home address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency contact name

Emergency contact telephone number

Number of adults attending

Number of children attending

Names and ages of everyone attending

Which this Home

How did you hear about this event?

Medical conditions, allergies, disabilities, accessibility requirements or additional needs we should be aware of.

Any other information you would like us to know.

Required confirmations

I understand this is a working farm with uneven ground, gravel paths and outdoor areas.
I understand there may be loose animals including horses, dogs, cats, poultry and other farm animals, and everyone attending is comfortable in this environment.
I have informed Elysian of any relevant medical conditions, allergies or additional needs.
Children and young people remain the responsibility of their accompanying adult at all times.
We will wear appropriate clothing and sturdy footwear suitable for a farm environment.
I will notify Elysian if I can no longer attend.
I confirm the information provided is accurate.

Do you consent to photographs being used by Elysian for marketing and publicity?