Complete the form below and we’ll be in touch with you.
Name known as:
Sessions required(Please tick)
Daytime contact no:
(They must be over 18 and be able to be contacted during playgroup hours.)
Relationship to the child:
Your child will only be able to leave our playgroup with those named above unless agreed in advance of collection.
Child's health visitor:
Was your child born prematurely?YesNo
If yes by how many weeks:
Any allergies, illnesses or current medication?
Does your child have any dietary requirements?
What language do you speak at home?
Is there anything else you would like to tell us about your child?
I give consent for my child to be taken to the doctor/hospital by a member of staff and to receive medical treatment if, in the opinion of a doctor/surgeon, a delay is likely to endanger my child's health or safety.
I give consent for my child to have their photo taken for displays in the playgroup or to be used on our private facebook page.
The FAR Centre, 40-46 Acanthus Avenue, Fenham,
Newcastle Upon Tyne NE4 9YD
0795 7717 366
© Go Far Playgroup 2019