Playscheme Registration Form

Childs Name:
Age:
Date of Birth:
Parent / Carers Name(s):
Address (inc. postcode):
Phone Numbers:
Email:
Emergency Contact (Name / Number if different from above):
Current primary school:
Any allergies or intolerances, if so details (inc. if allergic to facepaints?):
Any Pre-existing medical conditions?
Are there any other special requirements that Playscheme should be made aware of?
Are you handing in any inhalers / epi-pens (or other medication)?

If Yes to above – please ensure handed to Play Leader or Deputy and that they are clearly labelled with child’s name.

I give permission for the above named child to participate in the activities of the Dodington Playscheme and give permission for emergency treatment in the event of an accident.

SIGNED (Parent / Carer):


DATE:

Your privacy is important to us and we would like to communicate with you about the council and its activities. To do so we need your consent confirm your consent by ticking the boxes below. You can grant consent to any or all of the purposes listed. You can find out more about how we use your data from our “Privacy Notice” which is available from our website or from the Council Office.

You can withdraw or change your consent at any time by contacting the council office.

We may contact you to keep you informed about what is going on in the council‘s area or other local authority areas including news, events, meetings, clubs, groups and activities. These communications may also sometimes appear on our website, or in printed or electronic form (including social media).
YesNo

We may contact you about groups and activities you may be interested in participating in.
YesNo

We may use your child’s photo in our newsletters, bulletins or on our website and Facebook page.
YesNo