Playscheme

1Your Details 2Enquiry Details

Your Details

Address

Enquiry Details

Flintshire County Summer Playscheme Programme. Consent for your child to attend play sessions.

Parent / Guardian

Relationship to Child

Main Phone Number

Alternative Phone Number

Child

Child's First Name

Child's Surname

Child's Date of Birth

Child's Registered School

Child's First Language

Child's Gender

Male Female Prefer Not To Say

Child Address

Session

Which sessions would you like to register for?

Morning (10:30am - 12:30pm) Afternoon (2:00pm to 4:00pm) Community Provision

Emergency Contact

Emergency Contact First Name

Emergency Contact Surname

Relationship to Child

Main Phone

Alt Phone

Medical

Doctor Full Name

Doctor Phone Number

Doctor Address

Any allergies (including penicillin)

Current Medication (e.g. inhaler)

Any previous medication (last 6 months)

Any impairments (hearing, visual etc)

Are there any of details we need to be aware of?

Declarations

By checking this box, I hereby grant my consent for photographs of my child to be taken while they are present at the playscheme site. These photographs may be used for posting on Flintshire managed social media platforms, as well as for promotional purposes and future campaigns related to the summer play schemes.

I consent

I understand that the play sessions are open access and that my child can come and go as they please. I agree to my child taking part in all of the activities including water games (Slides & water game toys) Under supervision. Please note: the council does not make any insurance provision for personal accidents or of loss of property to children where no negligence is involved.

I Agree

In the event of any accident or the require ment of first aid to be administered, I give my consent to any emergency treatment necessary during the course of the session.

I Agree

I confirm that I have read and accurately completed the form and should any details change the playworkers will be made aware immediately.

I Agree

Playscheme

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Your Details

Address

Enquiry Details

Parent / Guardian

Child

Session

Emergency Contact

Medical

Declarations