Play Scheme Registration Form
Child's Details
*
Full Name
Child's Date of Birth
Parent or Guardian Name
*
First Name
Last Name
Contact Details
*
Contact Email Address of Parent or Guardian
My Relationship to Child (e.g. Parent or Guardian)
City
Contact Phone Number of Parent or Guardian *
Postal / Zip Code
Contact Email Address of Parent or Guardian
example@example.com
Emergency Contact Details
*
Emergency Contact Name
Emergency Contact Number
City
Contact Phone Number of Parent or Guardian *
Postal / Zip Code
Consent for Emergency Medical Treatment
*
Please Select
Yes, I give consent
No, I do not give consent
Registered Name and Address for Child's Doctor
*
Does Your Child Have Special Educational Needs (SEN)
*
Yes
No
If Yes - Please provide details so that we can make any adjustments needed.
Consent for Photos/Social Media
Yes, I Give Permission for All Promotional Activities
Yes, I Give Permission for Photos Only
Yes, I Give Permission for Video Only.
No, I Do Not Give Permission for any promotional Activities
Submit
Should be Empty: