Active Explorers Consent Form

Please read through this form carefully. Ticking the boxes and submitting this form provides us with your consent for your child to attend Jubilee Active Explorers Summer Kids’ Club and tells us that you have read and understood all the terms by which your child will be cared for. This club is operated by Jubilee Park Woodhall Spa Limited (JPWS).

Parent/Guardian’s Name *

Ticket Reference / Dates Attending *

E-Mail *

Your Phone Number *

Child’s Full Name *

Child’s Date of Birth *

Child’s Age *

Child’s Home Address *

Please read and answer the following statements to give your permission for the following:

ALLERGIES

Please confirm whether your child has any allergies, no matter how mild *

Please provide full details of any allergies here, including EpiPen details if relevant:

SEN

Please confirm whether your child has any SEN conditions, whether diagnosed or undiagnosed *

Please provide full details of any SEN conditions here, including medication details

OTHER INFO

I agree that JPWS has no liability for any damage/loss to electronic devices that do not belong to JPWS (i.e. iPads, Nintendo DS, etc). No mobile phones will be allowed in the setting. *

I agree for my child to be applied with sun protection cream by a staff member as and when required (to be supplied by parent). *

I agree for my child to receive help, if needed, with dressing after swimming or changing into clean clothes in the event of a toileting mishap. *

I agree that staff members at JPWS may take photographs of my child undertaking activities whilst in their care. *

I agree that my child’s images can be included on the JPWS website and Facebook/Instagram pages. These images will be stored and may be used by JPWS for up to 4 years.

I consent for my child to play outside in the playground area, poolside area and the park and occasionally be taken out of the park as part of the daily activities. *

I agree for staff to share information with other professional bodies if this is necessary for the safety and protection of my child but also understand that I will be informed*.

*Except in Child Protection cases where it is judged that the child may be placed further at risk. *

I agree for a staff member to administer first aid as necessary on any minor injuries that occur and I understand that I will always be informed after this has occurred and will sign the accident book to witness it.

I consent for any staff member at JPWS to administer prescribed medicine / Calpol to my child whilst they are at the setting, as directed by the Kids Club Lead, in accordance with the completed medicine administration form. I will always be informed before this is undertaken. All medicines to be provided by parents/carers and taken home at the end of each day. *

I consent for any staff member at JPWS to call an ambulance or take my child to the nearest Accident and Emergency department to be examined, treated* or admitted as necessary on the understanding that l/we have been informed at the earliest opportunity and are on my/our way to the hospital. *

*Please state if there are any exceptions to this i.e. blood transfusions and give details below:

Emergency Contacts

Emergency Contact 1:

Name *

Relationship to child: *

Mobile No: *

Alternative Phone No: *

Address *

Emergency Contact 2:

Name *

Relationship to child *

Mobile No: *

Alternative Phone No: *

Address: *

I confirm that I have answered all questions accurately and honestly. *

I agree to the terms and conditions laid out in the Privacy Policy *

Active Explorers Consent Form

ALLERGIES

SEN

OTHER INFO

Emergency Contacts

Emergency Contact 1:

Emergency Contact 2:

Our Park

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