Registration Form

Once you have booked your session, please ensure that you have filled out a registration form for EACH of your children(first timers only).
Failure to do so will prevent you from being allowed to attend the session.

Please familiarise yourself with our Terms & Conditions

Parent/Guardian Name

First Name

Last Name

Child's Name

First Name

Last Name

Child's Date of Birth

YYYY

Contact Email

Contact Phone Number

(###)

###

####

Emergency Contact Number

(###)

###

####

Relationship to Child

Alternative Emergency Contact Number

(###)

###

####

Relationship to Child

Please list all named person(s) and relationship to child who may collect the child

You will be required to let us know at time of drop off who will be collecting.

Password for those who can collect

Please give details of any allergies, dietary requirements, additional needs or medical conditions

The session includes a snack for your child.

Please give details of any other settings or childcare setting that your child attends

I hereby agree to using the nappies, water wipes and sudocream provided by the club.

You are welcome to bring your own if you prefer.

I hereby give permission for plasters to be applied to my child if necessary

I hereby agree that during the care of my child, the staff at Amersham Kids Club may take photographs/record videos of my child which may be used solely for marketing purposes of the club on the website and social media.

I hereby agree to the staff of Amersham Kids Club to administer any emergency treatment necessary for my child. This could also include contacting the emergency services, should the situation prevail, or transport to emergency care if we feel this would be the best option for your child.

Registration Form

Home
Book Sessions
Join Waitlist
Our Story
Team

miriam@amershamkidsclub.co.uk

Registration Form

HomeBook SessionsJoin WaitlistOur StoryTeam

miriam@amershamkidsclub.co.uk

Home
Book Sessions
Join Waitlist
Our Story
Team