Application 2025/26 | Stay 'n' Play

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Application - 2025/26

Child's full name*

Date of Birth *

Month

Day

Year

Address*

Phone number*

Any relevant medical history or allergies?*

Preferred Session*

Morning- Templepatrick

Afternoon- Mallusk

Preferred days (minimum 3 days)*

Monday

Tuesday

Wednesday

Thursday

Friday

Parent/Guardian names and phone number.*

Emergency contact (1) name and relationship to child.*

Emergency contact (1) phone number*

Emergency contact (2) name and relationship to child.*

Emergency contact (2) phone number*

Names of people with permission to pick up child.*

Name of child's Health Visitor *

Do you give permission for your child to use our equipment at Stay'n' Play.*

Yes

No

Do you give permission for your child's photo to be taken for Stay 'n' Play purposes?*

Yes

No

Do you give permission for your child's photo to be used for social media and advertising?*

Yes

No

Do you give permission for your details to be held for GDPR purposes?*

Yes

No

Please provide a memorable word to use as child's password.*

Name of Parent/Guardian submitting application.*

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