Jesse Tree Registration Form - Word document

Adults (Your) Name:

 

Child 1 Name:

 

Date of Birth:

Child 2 Name:

 

Date of Birth:

Your Home Address:

 

 

 

Home Telephone Number:

 

Mobile Number:

Email Address:

 

Are you first aid trained (in case of accident or emergency)?

 

      Yes (Date of Expiry):                                                                  No       

 

EMERGENCY CONTACT DETAILS – The emergency contact must be a suitable person who is able to come and collect you and/or any of the children within your care, if need be.

Name:

 

Relationship to you:

 

Telephone Number:

 

Address:

 

 

 

DECLARATION

I agree that I am responsible for the behaviour of my child at all times while attending The Jesse Tree Stay & Play and have read the copy of the ‘rules of safety and enjoyment’ which is pinned on the notice board and found on the sjpb.org.uk website.

 

Signature:                                                                                                                        Date:

 

Our contact phone number is 07907779814. We would like to contact you with news throughout the year. To be informed about events and other information, are you happy to join the Jesse Tree WhatsApp group?

 

         Yes                                           No

 

 

If you ticked NO, how would rather be contacted?

 

         Text Message                                              Email                                                      Post

   

 

Have you had your COVID-19 vaccination?

 

         Yes                                           No