Register your child

Please fill out the short form below for your child to come and play. If your child is already registered you can use this form to notify us of any changes. e.g. new mobile number!

To be completed by Legal Parent/Guardian.

Young Persons First Name

Young Persons Last Name

Young Persons Date of Birth (dd/mm/yy)

Address

Postcode

Parents/Guardians Name

Address (If different from above)

Postcode

Contact Tel No.

Alternative Tel No.

Email Address

Complete this if you want to receive publicity regarding services for your child. Your email address will not be shared with 3rd parties.

Emergency contact if Parent/Guardian is unavailable

Please provide a name and contact number.

Does your child have any of the following

if YES please check the boxes below.

Learning or behavioural difficulties

Physical disability, mobility difficulties

Conditions requiring medical treatment

Allergies i.e. Medication, Face Paint etc.

Any special dietary requirements

If you have answered YES to any of the above please give details below.

DECLARATIONS

1) I undertake to inform the playscheme leader of any changes in the information given in this form. 2) I consent to any emergency treatment necessary during the course of activities. I therefore, authorise the playscheme leader(s) to sign on my behalf, any written form of consent required by hospital authorities should a surgical operation or serum injection be deemed necessary and provided that the delay required to obtain my signature might be considered in the opinion of the Doctor or Surgeon concerned, likely to endanger my child's health and safety. 3) I understand that this is not a child minding service and that children are free to come and go as they please. 4) I consent to images of my child being used in young peoples multi-media projects and promotional materials produced by the playground. 5) I give consent for my child to take part in henna tattoos/temporary tattoos/face painting/water play/nail art.

Accept declarations

Come and get involved!

Register your child

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