Jumping Jakes & Kids United Heygarth
Breakfast, After School & Holiday Club

Registration Form

Childs details
First Parent Guardian details
Please enter title, first name and surname
Second Parent Guardian details
Please enter title, first name and surname
Emergency contact details
Please provide details for two people we can contact in an emergency (if we can't contact you)
Emergency contact details 2
Please provide details for two people we can contact in an emergency (if we can't contact you)
Childs doctor
Emergency treatment
If my child requires immediate medical treatment before I will be able to get to the doctor / hospital I authorise the manager, or a delegated member of staff, to consent to medical treatment on my behalf. I understand that this authorisation will remain valid unless I contact the manager to withdraw it.
About your child
Please list persons authorised to collect your child:
Persons not listed will not permitted to take the child from the scheme without your prior permission directly to the scheme
Sun protection
On sunny days staff will apply Nivea 50 sun lotion to children who have not had any applied and where consent is given here.
Terms and Conditions
Please enter your name and the date below - this is equivalent to signing the form.