Page 2 of 2

Hastings Adventure Playground

The Old Coachworks - Upper Broomgrove Road

Hastings - TN34 3PH

Email: / Tel: 01424 421201

Registration and Consent Form

The Adventure Playground is designed to provide a wider range of play opportunities to children. These will include climbing, building, art and craft, games, fire making and junk modelling. Many ideas will come from the children themselves as they play.In2play staffare present at play sessions to support children in an exciting outdoor play environment.

For safety purposes, please could you provide the following details:

Child’s details

First name: ______Last name: ______

Date of birth: ______Gender: Male  Female 

School:______

Parent/ carer details

Name of Parent / Carer: ______

Address:______

Post code: ______Tel No: ______Mobile: ______

Emergency contact name: ______Tel No: ______

Does your child have any known allergy or medical condition that could affect them during play sessions? If yes, please tell us here:

______

Does your child have any needs that we should think about when planning sessions? If yes, please tell us here:

______

______

PLEASE TURN OVER

Does your child have any special likes, dislikes or fears? Can you tell us how you promote positive behaviour at home?

______

I consent to our data being used solely to enable the setting to provide care and education to mychild in partnership with me. Information will only be provided to third parties with my permission.

I understand personal data held by the setting will be for specific purposes, such as to be contacted in case of emergency. I understand these details will be kept for two years after my child leaves the setting.

I agree that photographs may be taken of my child engaged in play activities at your session if needed for promotion of the group.

YesNo 

I understand that playworkers will provide activities to promote play opportunities.

Children are free to come and go as they please, although staff will encourage children to stay for the whole session.

The Adventure Playground is designed as a challenging environment for children aged 8 – 13 years of age.

Signature of Parent / Carer ______Date______

I give permission for medical advice and assistance to be sought for my child in the event of an emergency.

Signed ______Date______

Please return this form to a Senior Playworker at the Adventure Playground.

PLEASE TELL US IF YOUR CONTACT DETAILS CHANGE

In2play Community Interest Company - for children and adults to learn, play and grow Company No. 5769372