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AKA Child & Parent Group Registration Form
Please complete all section of the registration form for the soft play sessions.
Please be aware AKA will need to share the information you have provided with Eden Softplay, as they are hosting the session.
If you have any questions or queries please contact us by email at:
Contact@aka-hwo.org.uk
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* Indicates required question
Consent to share with Eden Softplay. Do you consent to AKA sharing the information you have provided with Eden Softplay. (Please note that a they are hosting the session this is a requirement)
*
Yes
No
Full Name (of Parent)
*
Your answer
Age (of Parent)
*
Choose
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Ethnicity (of Parent)
*
Choose
Black - African
Black - Caribbean
Black -Other
White - English, Welsh, Scottish, Northern Irish or British
White - Irish
White - Gypsy or Irish Traveller
Any other White background
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Any other Mixed or Multiple ethnic background
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Any other Asian background
Arab
Other ethnic group
Email
Your answer
Mobile
Your answer
Home Postcode
*
Your answer
Home Address
Your answer
Gender (of Parent)
*
Male
Female
Non-binary
Prefer not to say
Prefer to self describe enter below in the other box
Other:
Do you have any medical issues? Is so please state below
*
Your answer
Do you have Asthma?
*
Yes
No
If yes do you need carry an inhaler?
*
Yes
No
Do you have any allergies (e.g. nuts, animals, pollen, bees stings etc)? If yes please list all.
*
Your answer
If you do have allergies, do you carry an Auto Injector Pen I.e. EpiPen?
*
Yes
No
Do you have any dietary requirements? (Tick all that apply)
None
Vegitarian
Vegan/Plant based
Pescatarian
Halal
Kosher
Gluten Free
Dairy free/Lactose intolerant
No red meat
Please describe any other dietary requirements we should be aware of.
Your answer
Emergency Contact
Please provide contact details for the someone we should contact in the event of an emergency.
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Childs Name/s (add the names of all children attending)
*
Your answer
Are your children under 4 years of age?
*
Yes
No
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