Registration Form

Section A

Child’s Details

If yes, we require a copy which will be stored confidentially. We also require that you notify us promptly of any changes to such orders.

Parent/Guardian details

Parent/Guardian 1

Parent/Guardian 2

Other adults with permission to collect your child

Adult 1

Adult 2

Health/Social care contact details
Other health/social care contacts, eg: Social Worker/Community Nurse

Contact 1

Contact 2

Section B

Health/Disability/Personal Needs

Please answer the following 10 questions, if you answer YES to any question please complete a separate Personal Needs Form as we may require further information.

Health/Disability

Medication

Allergies

Eating/Drinking

Personal Care

Mobility

Communication

Behaviour

Cultural Practice

Other Personal Needs

Section C

Consent

• I understand the questions on the form and have given full replies to them. I know that if I have answered yes to any questions within Section B I must fill in a ‘Personal Needs form’.

• I confirm that I have parental responsibility for the child named in this registration form.

• In the event of any publicity/promotion in relation to PACE, I give my permission for photographs of my child to appear. This may include PACE leaflets, newspapers, be part of an exhibition, or on a LB of Camden/partners website.

• I give my consent for sun block to be applied on my child.

• I give my consent for PACE to gather and share information with relevant professional groups in order that my child receives a safe and appropriate level of care.

• I give my consent to any medical treatment necessary during PACE activities, and therefore authorise PACE staff to sign on my behalf, any written form of consent required by hospital/medical teams. This is provided every effort has been made to reach me, and that delay in treatment is likely to endanger the child’s health or safety in the opinion of the doctor or hospital.

Consent for supervised outings

The playcentre sometimes organises outings, travelling on public transport and/or hired coaches or minibuses (all hired vehicles are fitted with seatbelts). Standard outings include activities like swimming, theatre, seaside excursions, city farm trips, and visits to parks and playgrounds. We would let you know beforehand if we were planning any other activities.

I give my consent for my child to participate in activities with the exemption of those listed above

Consent to leave/arrive at play provision unaccompanied

If you want your child to arrive and/or leave the playcentre unaccompanied, you must provide written consent. Children aged 8 and under are not permitted to arrive/or leave the play project unaccompanied.

Section D

Monitoring

PACE aims to provide access to all children. In order to ensure this, it is important to monitor who uses our services.

Please help us to gather this information by completing the form below.

Ethnic Origin
Our ethnic background describes how we think of ourselves. Ethnic background is not the same as nationality or country of birth. The groups listed below reflect the largest ethnic groups in Camden.

Health and Disability

The Disability Discrimination Act (1995) defines a disabled person as someone who has a physical or mental impairment that has a substantial and long term adverse effect on his or her ability to carry out day to day activities.