Sample child registration form
This is a sample form for a one-off crèche at a one day community event.
You should think about what particular information you will need, and change the form to
suit your needs.
Child’s name
Child’s date of birth
Your name
Mobile phone number
Your relationship to the child
Your address
Where will you be while your child is
with us?
(Where can we find you if we need
to?)
What time will you be returning to
collect your child?
Does your child have any medical
conditions that we should know
about? Please explain.
Is your child allergic to anything?
Please list.
In the event that I cannot be reached in an emergency, I agree to medical
treatment being given to my child
Signature of
parent/guardian__________________________________________________________
Name of parent/guardian
_____________________________________________________________
Date: _______________________