Summer Play Scheme Registration | Cove Pavilion Pre-School

Registration

Please complete the registration & booking details below:

Child's Name

Sex

Date of Birth

Address

Post Code

Parent/Guardian Name

E-mail

Address (if different)

Telephone - (Home)

(Work)

(Mobile)

If your child will be dropped off and collected by other than the Parent/Guadian please give details:-

Name

Relation to Child

Address

Contact Telephone

In case of an emergency or sickness is the Parent/Guardian the first point of contact?

If NO, please give details:-

Name

Relation to Child

Address

Emergency Contact No

Medical

Please complete the medical details below:

Name of Doctor

Telephone

Surgery Address

My child been immunized against Tetanus

- Tetanus Date (approx)

Allergies

e.g. Penicillin, plasters, food
and any treatment required.

Vegetarian

The doctor has prescribed (as follows) for my child:-

All medicines must be clearly labeled.

Medicine

Frequency

Dosage

Medicine

Frequency

Dosage

Medicine

Frequency

Dosage

I give consent for my child to receive any necessary treatment as advised by a registered medical practitioner, for any accident or illness arising while my child is in the care of Cove Pavilion Play Scheme: (Please tick to agree)

I consent for the play scheme staff to apply sun cream to my child if staff feels this is necessary (supplied and clearly named and labeled by parent).

Booking

Please complete the booking details below:

This is my child attending the Summer Play Scheme.

Please Tick	Standard Day £24	Standard Day £24	Standard Day £24	Standard Week £65
Wk 1	Tue 23rd July	Wed 24th July	Thu 25th July
Wk 2	Tue 30th July	Wed 31st July	Thu 1st Aug
Wk 3	Tue 6th Aug	Wed 7th Aug	Thu 8th Aug
Wk 4	Tue 13th Aug	Wed 14th Aug	Thu 15th Aug

When we receive and confirm your booking we will request a payment of £0.

Click the button to confirm your request and send us the details. We will then be in touch.

Thank You

We will be in touch to confirm your booking.

Cove PavilionSummer Play SchemeOnline Booking

Registration

Medical

Booking

Thank You

Cove Pavilion
Summer Play Scheme
Online Booking