Please complete a separate form for each child you’d like us to care for. We will do our best to accommodate any requests. Please stay on site and have your primary phone to hand in case we need to contact you. Please ensure your child is sent with;

• Any medication they may need, named with instructions
• Nappies/wipes/change of clothes if needed
• Any food or drink they may need

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Event Details

Date *

Venue *

Parent's Details

Parent or Guardian Name *

First

Last

Email *

Phone

If we need to contact you during the event we will use this number.

Child's Details

Name of child *

Please use the name they prefer to be known as.

Child's gender *

• Male
• Female

Child's age *

Routine/Care needs

Please let us know how best to care for your child and anything we may need to know to ensure they are happy.

Medical

Parent's child Intimate

Does your child have any medical conditions/disabilities? *

• Yes
• No

Does your child have any known allergies *

• Yes
• No

Does your child have prescribed medicine? *

• Yes
• No

Does your child have any additional needs (SEND)? *

• Yes
• No

Please provide details.

If medication is required it needs to be named with full instructions.

Consents

Please let us know if you consent to us:

Intimate care *

• Consent
• Do not consent

Changing nappies, changing clothes, assisting in toilet, etc

First aid *

• Consent
• Do not consent

Administering any prescribed medications and first aid

Can the child leave the setting alone? *

• Yes, my child is over 8yrs old and can sign themselves out
• No, an authorised adult must collect the child

Who can collect the child *

Please list names of all people who can collect

Collection password *

This will be required when you collect your child to ensure we are handing them to an authorised adult.

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