Registration Form | Mini Explorers Club

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Mini Explorers Club
Registration form

Child's Details

First name

Surname

What does s/he like to be called

First Language

Current Age

Date of birth * required

Parent / Guardian Details

Contact First Name

Contact Last Name

Home Address

Does this child normally live at this Address * Required

Yes

Work Address

Home Phone Number

Mobile Phone Number

Work Phone Number

Contact Email

Does this person have parental responsibility? * Required

Yes

Does anyone else have parental responsibility for this child? (If yes, please provide details below) * Required

Yes

Contact First Name

Contact Last Name

Home Address

Does this child normally live at this Address

Yes

Work Address

Home Phone Number

Mobile Phone Number

Work Phone Number

Contact Email

Does this person have parental responsibility?

Yes

Does anyone else have parental responsibility for this child? (If yes, please provide details below)

Yes

I agree to provide Emergency Contact Details (please provide details of two people we can contact if we are unable to get hold of you)

Name

Telephone number

Mobile number

Select an Address

Relationship to child

Name

Telephone number

Mobile number

Select an Address

Relationship to child

Name of child's Doctor

Doctors Address

Doctor's Phone

About your child (including any toileting needs)

Signature of Parent/Carer

Dietary Requirements

Date * required

Is your child * Required

Independent on the toilet?

Needs help with toileting?

In nappies?

I have read and agree to our Intimate Care Policy and are happy for us to assist in changing/helping chidren on toilet and undressing/dressing etc in case of accidents or soggy clothes!

I consent to photos being taken and used on social media and the website. * Required

Yes

Thanks for submitting! All information will be kept confidential in line with our Data Protection Policy and our Privacy Notice.

Terms & Conditions

FAQ

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Mini Explorers Club Registration form

Child's Details

Parent / Guardian Details

Mini Explorers Club
Registration form