Childcare Consent Form

    Childcare Consent Form

    All fields are required.

    Child’s name

    Parent/carers name

    House Number & Street



    Post code

    Your Email

    Your Phone Number

    Your Mobile Number

    Childs date of birth

    Emergency Contacts

    This must be other than details already given.

    Contact 1 - Name

    House Number & Street



    Post code

    Phone Number


    Contact 2 - Name

    House Number & Street



    Post code

    Phone Number

    Medical History

    Family Doctor

    Phone number

    Health Visitor (if applicable)


    Ethnicity: please select one


    I consent to my child having prescribed medicines administered as described in section 7, ‘Medical Conditions & Special Diet Notes’YesNo

    I consent to my child participating in off site outingsYesNo

    I consent to my child having their photograph taken for use in the Setting and for publicity

    I consent to my child participating in face painting activitiesYesNo

    I consent to the setting staff administering Emergency First Aid and to seek necessary medical advice or treatment as requiredYesNo

    I consent to my child having sun screen applied as requiredYesNo

    Cancellation requires 5 working days notice or full payment is chargedYesNo

    I consent to my child's images (photo, video etc) being used on social mediaYesNo

    Please tell us of any medical conditions or special diet requirements your child has:

    General notes: Please tell us about your child's interests, likes and dislikes, etc:


    Policies and Procedures

    I have been informed about the settings policies and procedures and understand that I can access them at any time.

    Click here to view our policies

    Bookings and Payments

    I have read and understood the information for parents and agree to the terms and conditions of booking in respect to cancellations and payments.

    Information sharing consent

    We want to make sure you understand what we'll do with the information you share with us and the information we routinely check regarding children and families.

    Why do you need me information?

    Lots of agencies may need to provide you with the right kind of support. All of them need to know your details. By collecting your information once and sharing it with others, we can provide you with the best possible integrated service across all agencies working with families in Barnsley.

    What information do you need from me?

    We'll ask for essential information, such as date of birth, address, schools attended and will routinely share this between the services involved in supporting you. This information will be held by the agency asking you for the information.
    We would only share additional 'sensitive' information with your knowledge and consent, if/when we have a reason to believe that not doing so could place your child at risk of significant harm.
    Your information is protected by the Data Protection Act 1998. This means that the information will only be used for the reasons for which we have shared it. It will be kept safe and secure by all agencies and you'll have the right to see what information is being kept about you. If you would like to see the information held about you speak to your worker who can arrange for you to see your records. If the service is a Local Authority service you can also write to the Executive Director, Children Young People and Families asking for permission to see your records.

    Who can see my information?

    Only agencies involved in providing a direct service to you and your child will be able to see the information.
    Where services are directly involved with older children and young people, practitioners will need to consider the capacity of the child concerned to be able to make their own decisions where this is appropriate. This is called Gillick Competence and Fraser Guidelines. This may mean that we provide services to your child without your knowledge or consent.
    We'll make every effort to support your child in sharing details of the information with you, but there may be circumstances in which we can't share details.
    We need to demonstrate the effectiveness of the services we provide for you, so we may use your data for audit purposes. If this is the case, your data will be anonymised.

    I have read and understand the information sharing consent and agree to the terms and conditions of this.

    If it doesn't say 'Your message has been submit sucessfully' please go back to check if you've ticked all the boxes and filled in every text box.