REGISTRATION FORM
PLAY RANGERS
Young Person’s
Name:
Gender:
D.O.B:
Address:
Postcode:
Allergies/ Medical
Conditions:
Emergency
Contacts
999
Consent:
Yes
No
Name:
Number:
School:
Name:
Number:
Contact Email:
Which Play Rangers site does your
child attend? (name of location)
Monitoring Information:
Information provided here will help us to ensure our activities are fully accessible to all groups. It will not be used for any other
purpose and will remain confidential.
White (e.g. British, Irish, etc)
Mixed (e.g. white & Black Caribbean etc)
Asian/Asian British (e.g. Indian, Pakistani etc)
Black/Black British (e.g. Caribbean, African etc)
Chinese
Other Ethnic Origin
Does the participant have an additional need?
Physical Disability
Learning Disability
Special Need
Hearing or Visual Impairment
Medical
Other (please specify) :
Parent/Carer consent & agreement
I understand that the Play Ranger project is an open access scheme, which means that my
children will be allowed to come and go. I also understand that it is not a childcare service and I
must be contactable in an emergency. Participants will be expected to follow the instructions
given by staff at all times. I consent to the named individual taking part in the activity detailed.
Terms and conditions of using service (PLEASE READ):

You must be aged between 5-16 years old.

Please respect staff, other Play Ranger users, the equipment, the grounds and the public

Warnings and bans will be given out for unacceptable behaviour such as bullying, fighting, damage to grounds /
property etc. Parents/Guardians will be contacted in the event of a ban being issued. Bans will be reviewed on a case
by case basis.

Your contact details will be kept on a secure database and not be passed on to any third parties.

The Council cannot accept liability for loss or injury other than where caused by own negligence.

By signing this form you agree to:
1. Allowing Three Rivers District Council Leisure Team email you information on other similar activities and events
being run in the district.
2. The participant may be photographed for marketing purposes. If you do not agree to photo consent please circle:
No Photo Consent
I agree to the above terms and conditions, I give my consent for the member to take part in all activities
and confirm that the member is aged between 5-16 years old.
Parent/Guardian
Print Name:
Signed:
Date:
Please complete and return this form to staff at the next play session.
Please ensure your child comes prepared for the session with something to drink and
appropriate clothing/footwear.