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COMPLETE YOUR CHECKIN
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I give permission for my child to fully participate in activities while visiting Girls Brigade.
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I consent to my child to being taken out on excursions with Girls' Brigade and using both public and private transport.
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I give my consent that any photographs taken of my child on Girls' Brigade activities can be used for Girls' Brigade Publicity.
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I have supplied health and dietary information and provided details of emergency contacts.
Yes
If I cannot be readily contacted in the case of an emergency, accident or illness I give permission for the leaders of Girls' Brigade to act in my place with the safety and welfare of my child being of utmost concern.
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I accept that the information I have provided in completing this form will be kept securely on record by GBNZ and will be used for administration purposes. Medical information has been given on the understanding that these details will be kept confid
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Allergies
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amoxicillin and penicillin
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Allergies
-cillian medicines (penticillin
etc.)
coconut
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Facepaint & Walmart brand sunscreen
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N/a
nut
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ricotta cheese
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seasonal
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peanuts
strawberries
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coconut
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-cillian medicines (penticillin
etc.)
coconut
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nut
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seasonal
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peanuts
strawberries
watermelon
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Benjamin Logan
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Benjamin Logan
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Benjamin Logan
Bellefontaine
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Homeschooled
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sa
saint merry
Universal Design Partners
liberty
fefe
L. P. Savani
Allergies
-
--
?
*NA
All nuts
sesame
soy
egg sorta
Anaphalactic - Nuts
eggs
kiwi
Anaphylactic to seafood
Anaphylaxis to bees
Anaphyllactic to all NUTS
peanuts
tree nuts
animal hair/skin
animals and grass
asthmatic
Bee
Bee Stings
bees
Cashew
pistachio
cashews and Pistacios
Celiac
Dairy
Egg
Nuts
dead memes
Dust mites
Fur
gluten
Gluten Free
fructose intolerant
GRASSSSS
Hay fever
hayfever
Insect Bites
Intolerant to sorbitol (found in fruit juices
sugar-free lollies
apples
pears
stone fruit
chewing gum)
Jelly Beans
Jelly
Animals
Lactose
Lactose intolerant
Latex Powder
Mango
mild bee
mild grass allergy; need to know CARBS in food
Mosquito
n
N/A
NA
nah
Naked Mole Rats
Nil
no
no pork or seafood
non
none
Nope
Not aloud Nurofen
not enny
nothing
Nut Allergy
Nuts (all)
treenuts
citrus seeds
chickpea
Peanut
penacilin
Penasilin
Penasilin + mild unknowns
Penicillin
pollum
Possibly shellfish
rash from sunscreen
Senstivty to Food Chemicals
sesitive skin
Shellfish
avocado
Sunscreen - bannana boat
Unknown
Vegetarian
Walnuts
Birthday:
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Nursery
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K
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Select Gender
Male
Female
Allergies
-
--
?
*NA
All nuts
sesame
soy
egg sorta
Anaphalactic - Nuts
eggs
kiwi
Anaphylactic to seafood
Anaphylaxis to bees
Anaphyllactic to all NUTS
peanuts
tree nuts
animal hair/skin
animals and grass
asthmatic
Bee
Bee Stings
bees
Cashew
pistachio
cashews and Pistacios
Celiac
Dairy
Egg
Nuts
dead memes
Dust mites
Fur
gluten
Gluten Free
fructose intolerant
GRASSSSS
Hay fever
hayfever
Insect Bites
Intolerant to sorbitol (found in fruit juices
sugar-free lollies
apples
pears
stone fruit
chewing gum)
Jelly Beans
Jelly
Animals
Lactose
Lactose intolerant
Latex Powder
Mango
mild bee
mild grass allergy; need to know CARBS in food
Mosquito
n
N/A
NA
nah
Naked Mole Rats
Nil
no
no pork or seafood
non
none
Nope
Not aloud Nurofen
not enny
nothing
Nut Allergy
Nuts (all)
treenuts
citrus seeds
chickpea
Peanut
penacilin
Penasilin
Penasilin + mild unknowns
Penicillin
pollum
Possibly shellfish
rash from sunscreen
Senstivty to Food Chemicals
sesitive skin
Shellfish
avocado
Sunscreen - bannana boat
Unknown
Vegetarian
Walnuts
Birthday:
Select Gender
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School
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11th Grade
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Young Adult
Allergies
-
--
?
*NA
All nuts
sesame
soy
egg sorta
Anaphalactic - Nuts
eggs
kiwi
Anaphylactic to seafood
Anaphylaxis to bees
Anaphyllactic to all NUTS
peanuts
tree nuts
animal hair/skin
animals and grass
asthmatic
Bee
Bee Stings
bees
Cashew
pistachio
cashews and Pistacios
Celiac
Dairy
Egg
Nuts
dead memes
Dust mites
Fur
gluten
Gluten Free
fructose intolerant
GRASSSSS
Hay fever
hayfever
Insect Bites
Intolerant to sorbitol (found in fruit juices
sugar-free lollies
apples
pears
stone fruit
chewing gum)
Jelly Beans
Jelly
Animals
Lactose
Lactose intolerant
Latex Powder
Mango
mild bee
mild grass allergy; need to know CARBS in food
Mosquito
n
N/A
NA
nah
Naked Mole Rats
Nil
no
no pork or seafood
non
none
Nope
Not aloud Nurofen
not enny
nothing
Nut Allergy
Nuts (all)
treenuts
citrus seeds
chickpea
Peanut
penacilin
Penasilin
Penasilin + mild unknowns
Penicillin
pollum
Possibly shellfish
rash from sunscreen
Senstivty to Food Chemicals
sesitive skin
Shellfish
avocado
Sunscreen - bannana boat
Unknown
Vegetarian
Walnuts
Dietary Requirements
How will you be released at the end of the night?
Going home with my parent/guardian
Going home with a friend's parent/guardian (please inform leaders of who)
Make my own way home (with parent's written permission)
Allergies
-
--
?
*NA
All nuts
sesame
soy
egg sorta
Anaphalactic - Nuts
eggs
kiwi
Anaphylactic to seafood
Anaphylaxis to bees
Anaphyllactic to all NUTS
peanuts
tree nuts
animal hair/skin
animals and grass
asthmatic
Bee
Bee Stings
bees
Cashew
pistachio
cashews and Pistacios
Celiac
Dairy
Egg
Nuts
dead memes
Dust mites
Fur
gluten
Gluten Free
fructose intolerant
GRASSSSS
Hay fever
hayfever
Insect Bites
Intolerant to sorbitol (found in fruit juices
sugar-free lollies
apples
pears
stone fruit
chewing gum)
Jelly Beans
Jelly
Animals
Lactose
Lactose intolerant
Latex Powder
Mango
mild bee
mild grass allergy; need to know CARBS in food
Mosquito
n
N/A
NA
nah
Naked Mole Rats
Nil
no
no pork or seafood
non
none
Nope
Not aloud Nurofen
not enny
nothing
Nut Allergy
Nuts (all)
treenuts
citrus seeds
chickpea
Peanut
penacilin
Penasilin
Penasilin + mild unknowns
Penicillin
pollum
Possibly shellfish
rash from sunscreen
Senstivty to Food Chemicals
sesitive skin
Shellfish
avocado
Sunscreen - bannana boat
Unknown
Vegetarian
Walnuts
Birthday:
Favorite Snack
T Shirt Size (ASP)
Emergency Contact
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diary
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penicillian
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eggs
peanuts
chocolate
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strawberries
pollen
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diary
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diary
gluten
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diary
gluten
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penicillian
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eggs
peanuts
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strawberries
pollen
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n/a
NA
Nickel adhesive
No
none
Nothing
Nuts but only when eaten
omnisef
sesame
hazelnut
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Campbellsville
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Taylor County
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Dietary Restrictions
Allergies
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bananas
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mosquitos
N/A
NA
No
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test 1
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Do you participate in any sports/clubs/activities?
What would your theme song be?
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Young Adult
Allergies
Bees
cats dogs elm trees grass weeds
NA
No
none
nut
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Allergies
Codine
N/a
None
?
.
A
Bees
Benadryl
Bla
Blayden
Boring people
Cat hair
Cats
Coconut
Dairy pork beef eggs sulfa-drugs
Dees nUts
Dirt
Eg tdb
Fish
FLllliti
G
ggg
Gluten and dairy
Gurls
I didn’t have none
Idk
Kd
Lavender and lactose
Lavender citrus cleaning supplies
N
Na
No
Noneeee
Nothing
Ñøńë
Nuts
Paper wasps
Peanuts and treenuts ( not peanut oil)
Penicillin and Celphlysporin
Pinnacillin
Seasonal
Sheh
Some type of medicine
but I don’t know
Stupid People
Sulfa
Sulfur
Tree nuts
Tree Nuts and Peanuts
Vjqgdvvbvdhc
Wheat
Yes
Allergies
Codine
N/a
None
?
.
A
Bees
Benadryl
Bla
Blayden
Boring people
Cat hair
Cats
Coconut
Dairy pork beef eggs sulfa-drugs
Dees nUts
Dirt
Eg tdb
Fish
FLllliti
G
ggg
Gluten and dairy
Gurls
I didn’t have none
Idk
Kd
Lavender and lactose
Lavender citrus cleaning supplies
N
Na
No
Noneeee
Nothing
Ñøńë
Nuts
Paper wasps
Peanuts and treenuts ( not peanut oil)
Penicillin and Celphlysporin
Pinnacillin
Seasonal
Sheh
Some type of medicine
but I don’t know
Stupid People
Sulfa
Sulfur
Tree nuts
Tree Nuts and Peanuts
Vjqgdvvbvdhc
Wheat
Yes
Allergies
Codine
N/a
None
?
.
A
Bees
Benadryl
Bla
Blayden
Boring people
Cat hair
Cats
Coconut
Dairy pork beef eggs sulfa-drugs
Dees nUts
Dirt
Eg tdb
Fish
FLllliti
G
ggg
Gluten and dairy
Gurls
I didn’t have none
Idk
Kd
Lavender and lactose
Lavender citrus cleaning supplies
N
Na
No
Noneeee
Nothing
Ñøńë
Nuts
Paper wasps
Peanuts and treenuts ( not peanut oil)
Penicillin and Celphlysporin
Pinnacillin
Seasonal
Sheh
Some type of medicine
but I don’t know
Stupid People
Sulfa
Sulfur
Tree nuts
Tree Nuts and Peanuts
Vjqgdvvbvdhc
Wheat
Yes
Allergies
Codine
N/a
None
?
.
A
Bees
Benadryl
Bla
Blayden
Boring people
Cat hair
Cats
Coconut
Dairy pork beef eggs sulfa-drugs
Dees nUts
Dirt
Eg tdb
Fish
FLllliti
G
ggg
Gluten and dairy
Gurls
I didn’t have none
Idk
Kd
Lavender and lactose
Lavender citrus cleaning supplies
N
Na
No
Noneeee
Nothing
Ñøńë
Nuts
Paper wasps
Peanuts and treenuts ( not peanut oil)
Penicillin and Celphlysporin
Pinnacillin
Seasonal
Sheh
Some type of medicine
but I don’t know
Stupid People
Sulfa
Sulfur
Tree nuts
Tree Nuts and Peanuts
Vjqgdvvbvdhc
Wheat
Yes
Allergies
Codine
N/a
None
?
.
A
Bees
Benadryl
Bla
Blayden
Boring people
Cat hair
Cats
Coconut
Dairy pork beef eggs sulfa-drugs
Dees nUts
Dirt
Eg tdb
Fish
FLllliti
G
ggg
Gluten and dairy
Gurls
I didn’t have none
Idk
Kd
Lavender and lactose
Lavender citrus cleaning supplies
N
Na
No
Noneeee
Nothing
Ñøńë
Nuts
Paper wasps
Peanuts and treenuts ( not peanut oil)
Penicillin and Celphlysporin
Pinnacillin
Seasonal
Sheh
Some type of medicine
but I don’t know
Stupid People
Sulfa
Sulfur
Tree nuts
Tree Nuts and Peanuts
Vjqgdvvbvdhc
Wheat
Yes
Birthday:
Allergies
-cillian medicines (penticillin
etc.)
coconut
Egg
Facepaint & Walmart brand sunscreen
Gluten
Hay and Grass
N/a
nut
Pennicillin
ricotta cheese
sage
seasonal
walnuts
peanuts
strawberries
watermelon
Birthday:
What is your favorite song?
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