Step by Step - Application Form

Application Form

Child Information

First Name *

Last Name *

Date Of Birth *

Please note we only accept from 3 years old

Address *

Address Line 2

City *

Town *

Post Code *

Email Address *

Phone Number *

Text Message Number *

Use +447 and don't leave any spaces

School *

Medical & Support Information

Is your child in receipt of DLA? *

Yes

In receipt of short breaks? *

Please state nature of child's disability *

Does your child have any specific medical or emergency procedure or any high risk factors that we need to be made aware of e.g. fits, hypothermia, low muscle tone, allergies *

If yes, an emergency procedure MUST be provided, with any relevant medication

Parent/Guardian Information

Mother's Information

First Name *

Mobile Number *

Father's Information

First Name *

Mobile Number *

Activities Interest

Tick which sessions you will potentially be interested in joining:
Sunday Club
Sports
Stay and play at High Road
Play-scheme (Winter/Summer)
Camp

Step by step would like to reassure you that any information, be it current or past is confidential and we treat confidentiality with utmost importance and do our very best to implement it with all our staff, volunteers and users.

Consent & Agreement

Signature

Please sign in the box, that the above is true and that you agree to the consents. *