Playscheme

Parent / Guardian

Relationship to Child

Main Phone Number

Alternative Phone Number

Child

Session

If your child has any disabilities and would benefit from participating in the Buddy Scheme, please choose a site designated as a Buddy Scheme Site from the dropdown menu. However, all our playschemes across all sites are inclusive for children of all abilities.

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 (e.g. penicillin) - leave blank if none

Current Medication (e.g. inhaler) - leave blank if none

Any previous medication (last 6 months) - leave blank if none

Any impairments (hearing, visual etc) - leave blank if none

Are there any of details we need to be aware of? - leave blank if none

If you have selected a Buddy Scheme site due to your child's additional support needs, please tick this box.

Monitoring

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

Parent / Guardian

Child

Session

Emergency Contact

Medical

Monitoring

Declarations