Step by Step - Application Form

Application Form

Child Info

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 *

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

Mothers Info

First Name *

Mobile Number *

Fathers Info

First Name *

Mobile Number *

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.

I consent to sharing any relevant information

It would be in the best interest of your child and our organisation to be able to share information and liaise with the school and any other relevant party your child is attending in regard to your child's IEP, emergency procedures and individual risk assessments.

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