AIva Play Pals

Please provide 2 contacts, (other than people used on previous page) which we can contact in case of an emergency and have permission to collect your child. You MUST notify us if anyone other than yourself, or adults listed below, will be collecting your child. We reserve the right to refuse unknown adults to take your child. Anyone collecting or dropping off your child must be 16 years or over.
Emergency Contact 1
Name*

First NameLast Name
Relationship to child*
Primary Number*
Secondary Number
Home Address*

Street Address line 1

Street Address line 2

Town

Post Code
Emergency Contact 2
Name*

First NameLast Name
Relationship to child*
Primary Number*
Secondary Number
Home Address*

Street Address line 1

Street Address line 2

Town

Post Code
Other people who may pick up your child (no more than 4 safe people)
Name
Number
Name
Number
Name
Number
Name
Number

Please select all permission you are happy to grant:
Any other relevant information?
Declaration

I agree to and confirm all of the above as indicated.
Parent/ Guardian's signature

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Date

DayMonthYear
Staff's signature

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Date

DayMonthYear
This information will be updated annually. Please give us all necessary information to keep your child safe. It is your responsibility to update personal details as and when necessary.

Scottish Charity Number SCO24114 Registered in Scotland Number 160988.
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Enrolment Form