Baltic Street Adventure Playground Registration Form
* Required
Name of Child
*
Your answer
Gender
*
Choose
Female
Male
Undisclosed
Date of Birth
*
MM
/
DD
/
YYYY
Home Address
*
Your answer
Parent or Main Carer Contact Details
Name
*
Your answer
Relationship to Child
*
Your answer
Main Contact Number
*
Your answer
Secondary Contact Number
Your answer
E-mail Address
Your answer
Alternative Emergency Contact Details
Name
Your answer
Contact Number
Your answer
Relationship to Child
Your answer
Main Contact Number
Your answer
Alternative Contact Number
Your answer
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.
Your answer
GP Name
*
Your answer
GP Contact Number
*
Your answer
GP Address
*
Your answer
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.
Yes, I consent for the child named above to be filmed and photographed on site
No, I do not consent for the child named above to be filmed and photographed on site
I would like to talk to a member of staff before confirming consent.
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.
I understand
I would like more information
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.
I agree
I would like more information
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