Adventure Playground users registration form
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All the information provided on this form will be shared between all four Adventure Playgrounds, and appropriate Council staff responsible for the management of Playgrounds, and therefore only one registration form will be required.
Please be aware that under the Children’s Act (date), we are obliged to report any concerns regarding child protection/ safeguarding to the relevant authority. Information is confidential and is only used with the safety of your child in mind.
Please your child's date of birth
Your child must be between 8 and 16 years old
Your child must be between 8 and 16 years old
Enter postcode:
Please enter your postcode
Even though you cannot see the address, you still need to put one in. If you know your postcode then input it and click 'Find address'. If you dont know your postcode then click on 'Enter manually'.
Main emergency contact Required
1st Contact name
Phone number
Relationship
Doctors Surgery and address
Enter your child's doctor's address. Enter the postcode and click 'Find address' or click 'Enter manaully'
Enter postcode:
Please enter your postcode
Even though you cannot see the address, you still need to put one in. If you know your postcode then input it and click 'Find address'. If you dont know your postcode then click on 'Enter manually'.
Has your child any of the following: (please tick if "YES")
Illnesses, conditions or allergies
If you have selected any of the above, please provide more detail about the condition otherwise enter 'none': Required
Please enter 'none' if none.
Is your child on medication? Please provide details or enter 'na' if not applicable: Required
Please enter if your child on medication? Type 'na' if not applicable
Important notice
Please note that if a child suffers illness or injury at this Adventure Playground and the parent(s) or guardian(s) of the child cannot be contacted immediately, either by telephone or otherwise, then the Adventure Playground staff will make speedy arrangements for the appropriate care of the child.
This may, of course, involve arranging for an ambulance to come to the scene of the illness or injury.
Equal opportunities monitoring
We are constantly looking to improve our service and our playgrounds are working towards being accessible to all children including those with special needs. To help us deliver the service as effectively as possible, we ask you to complete this monitoring section of the form.
Dacorum Borough Council has a clearly stated equal opportunities policy and warmly welcomes all people.
Please fill in and tick boxes where appropriate on the following information:
What is your child’s ethnic group?
Please confirm that you have read our policies . Required
Signed: Required
Dated: Required
Please complete the validation below: