Child's First Name
Child's Last Name
Child's Date of Birth (dd/mm/yy)
Parents Status
Please select Parents live together Parents are separated and live apart Single Parent
Parents/Guardians Name
Address/s
Post Code
Home Telephone Number
Mobile Telephone Number
Email Address
Above parent/guardian is legally responsible
Other Parent/Guardians Name
Telephone
Contact Name
Contact Relationship to child
Please select Mother Father Grandfather Grandmother Aunt Uncle Guardian Brother Sister Friend Relative
Allergies/Health Problems/ Food Intolerances
Please enter None if your child has no medical conditions
In the event of an emergency where the staff are unable to contact me or the emergency contact, I give my permission for the staff leading the session to act on my behalf and provide any necessary permissions for treatment on my child to a doctor.
As part of our commitment to ensure the welfare of your child it may be necessary to share information with other agencies. This may be the school your child attends or other linked professionals.
Payment for the term is due by the last day of the previous term.
Method of payment: Please select BACS Cash Cheque (payable to Bisley Base Ltd) Voucher
Once your registration has been accepted, you will be requested to sign a printed copy of this application
I agree to the terms and conditions