Hitchin Fun Club

Registration

CHILD’S CONFIDENTIAL PERSONAL RECORD

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Mother's details

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Father's details

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Child/Medical details

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We must be informed of any special allergies/diet/disabilities/health problems so that your child can be looked after appropriately. If applicable please provide details below.

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Do you give permission for staff to apply sun cream to your child? (Our club use Factor 30 sun cream)

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May we seek emergency medical treatment for your child at hospital or at the doctors?

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If yes, please specify

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Do you give permission for your child/children to be photographed? These photos will only be shown at the Club, they will not be put on the internet. We will seek permission for special occasions.

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Anything else the Playleader should know about your child:

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Please provide a photograph and more information if your child has any allergies, dietary or medical conditions.

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Please click on the "browse" button to upload a photo of your child.

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Please provide as much information as possible about your child's allergies, dietary requirements or medical conditions below.

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I have read and understand the Policies, Procedures and Practices for Parents/Carers and agree to abide by them. Failure to follow these rules and regulations may result in your child losing their place with us.

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The person completing this form should sign in the space provided.

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This email address will be the address your registration confirmation will be sent to.

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If 'other' please specify.

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State relationship if not parent or guardian

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