Baltic Street Adventure Playground Registration Form
Name of Child *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Home Address *
Parent or Main Carer Contact Details
Name *
Relationship to Child *
Main Contact Number *
Secondary Contact Number
E-mail Address
Alternative Emergency Contact Details
Name
Contact Number
Relationship to Child
Main Contact Number
Alternative Contact Number
Further Details
Does the child have any special needs? *
Please let us know about any allergies, medication, dietary requirements or anything else which might impact on the care the child will need on site.
GP Name *
GP Contact Number *
GP Address *
Do you consent to the child featuring in photographs and videos taken on the playground? *
From time to time, children may be photographed, filmed or otherwise recorded whilst on the playground. The materials are used for monitoring and promotional purposes, including occasional publications, including articles and reports about the playground. By ticking yes, you are acknowledging that you have completely read and fully understood this, and grant consent for you child to be photographed or filmed for the mentioned purposes. If you would like to talk to member of staff about this in more detail, please get in touch.
Confidentiality and Sharing Information *
We will handle the Information you have provided in line with the provisions of the Data Protection Act . Under the data protection act you have the right to make a formal request in writing to access personal Data held about you.
Declaration *
I agree that in case of an accident or emergency the child may receive medical attention from first aiders on site, and if necessary, staff can seek further emergency care for the child. I will inform the Adventure Playground staff of any changes in the child details, changes to parent/guardian due to court order, medical or other circumstances. I understand that Baltic Street Adventure Playground does not offer childcare on site, and that all children are free to come and go as they choose during sessions.
Submit
Never submit passwords through Google Forms.
This form was created inside of Assemble. Report Abuse