Child Registration

In order for us to process your booking, please complete the following Registration Form and submit.

You only need to do this once – for subsequent bookings you can simply tick the box, unless there are any changes to be made. Please note, that when booking your child onto a Wild Play session, you are responsible for ensuring that all details and information is correct at the time of booking.

Child's Name

Gender

Child's Date of Birth

I am happy for Wild Play to use images / video of my child for publicity purposes - names will NOT be used I am happy for Wild Play to use images / video of my child for publicity purposes - names will NOT be used Yes No

Child's Medical Conditions & Medication Requirements inc. Dosage

Child's Allergies

Child's Dietary Needs

Child's SEND / Physical Restrictions

Parent Name

Parent Contact Number

Email Address

Emergency Contact Name & Number

Home Address

List Of People Authorised To Collect Child

Does Your Child Have Any Particular Interests?

Is There Anything That May Worry Your Child?

I Have Read And Agree To The Terms & Conditions I Have Read And Agree To The Terms & Conditions I Agree

I am aware that Wild Play Ltd sessions may also include the use of tools / fire and I confirm that I give consent for my child to take part. I am aware of the risks involved and that Wild Play Ltd will take all appropriate measures to reduce the risk of harm to all participants. I am aware that Wild Play Ltd sessions may also include the use of tools / fire and I confirm that I give consent for my child to take part. I am aware of the risks involved and that Wild Play Ltd will take all appropriate measures to reduce the risk of harm to all participants. I Agree

I Give Consent For Medical Intervention In The Event Of An Emergency I Give Consent For Medical Intervention In The Event Of An Emergency I Agree

2 + 12 =

Any questions? Email us at info@wildplayltd.co.uk or call us on 07043 219 594 or 07962 080 091