Please fill in all the information below. We look forward to seeing you all soon.

Childs Full Name:

Parent/Guardian Name:



Email Address:

Childs Age:

Childs Date of Birth:

Parent Telephone Number:

Parent Mobile Number:

Email Address:

Emergency contacts:
Please could we have the name and address of two emergency contact people?

Contact One Name:

Contact One Address:

Contact One Number:

Contact Two Name:

Contact Two Address:

Contact Two Number:

Health: Please use this space to let us know about any illness or previous treatment that you feel is important for us to know? Please ensure that you include all medications that your child needs to take.

Diet: Please let us know about any dietary needs that you feel that we should be aware of?

Do you have a disability?

Are you happy for your child to walk home by themselves – please note this is only for children aged 10+?


Health: In the unlikely event of an accident or an emergency please agree to the consent below for your child to receive medical attention.

Media and Information Sharing: We take photographs/video of the children for advertising and marketing through the internet and social media platforms such as, Facebook, Instagram.


Play Place polices are a working document that safeguards families who use our provision. Policies are available at all times for parents to read, these can also be found online at: