Bismillah Babies Playgroup Registration
Parent / Guardian's Full Name
*
Mr.
Mrs.
Title
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Would you like to be added to our WhatsApp group to receive updates on upcoming sessions?
Please Select
Yes
No
Number of children attending the playgroup
Please Select
1 child
2 children
Child 1
Child's Full Name
*
Child's Age
*
Child's Date of Birth
*
-
Day
-
Month
Year
Date
Your relationship to the child
*
Please Select
Mother
Grandmother
Aunt
Sister
Other
Does your child have any additional learning or developmental needs that we should be aware of?
*
Please Select
Yes
No
Does your child have any allergies?
*
Please Select
Yes
No
If yes, please specify the allergen and nature of the allergy
Child 2
Child's Full Name
Child's Age
Your relationship to the child
Please Select
Mother
Grandmother
Aunt
Sister
Other
Does your child have any additional learning or developmental needs that we should be aware of?
Please Select
Yes
No
Does your child have any allergies?
Please Select
Yes
No
If yes, please specify the allergen and nature of the allergy
Emergency Contact Information
Name of Emergency Contact
*
Mr.
Mrs.
Title
First Name
Last Name
Relationship to the child / children
*
Phone Number
*
Disclaimer for Parent / Guardian
Please read the following statements carefully and acknowledge your understanding and agreement by selecting the appropriate option below:
Supervision Responsibility: I understand that as a parent or guardian, it is my responsibility to supervise my child/children at all times and ensure their safety throughout the playgroup session.
*
I agree
Allergy Awareness: I acknowledge that if my child has any food allergies, it is my responsibility to clearly communicate these allergies to the playgroup organisers. I will take proactive measures to ensure my child does not consume any foods they are allergic to during snack time.
*
I agree
Health and Well-being: I understand that if my child is unwell or displaying symptoms of illness, it is my responsibility to keep them at home and not bring them to the playgroup. Specifically, if my child has: 1) a fever (temperature of 38°C or higher); 2) diarrhoea or vomiting 3) an infectious illness. I will ensure that my child remains at home until they have fully recovered to prevent the potential spread of illness to others.
*
I agree
Photographs and Videos: We may capture photographs and videos during the playgroup sessions. These images and videos will be shared only within the Bismillah Babies Playgroup closed WhatsApp group and that those shared on social media will not include children's face to protect their identity.
*
I agree to my child's photos/videos to be shared on the closed WhatsApp group and social media (no faces)
I agree to my child's photos/videos to be shared on the WhatsApp group but not on on social media
I do not wish for my child's photos/videos to be taken or shared
Date
-
Day
-
Month
Year
Date
Signature
SUBMIT RESPONSES
SUBMIT RESPONSES
Should be Empty: