Child form

Please use the form to add child to the booking system.

Your details will be submitted securely. Fields marked with a (*) must be completed. Please only click on the ‘Submit’ button once.

Email Address *

Please confirm your email address to help us match the child to your account.

Child's name *

First

Last

Gender *MaleFemaleIntersexNon-binaryTransgender

Ethnicity *Asian/Asian British: BangladeshiAsian/Asian British: ChineseAsian/Asian British: IndianAsian/Asian British: Other AsianAsian/Asian British: PakistaniBlack/African/Caribbean/Black British: AfricanBlack/African/Caribbean/Black British: CaribbeanBlack/African/Caribbean/Black British: Other BlackMultiple Ethnic Groups: White and AsianMultiple Ethnic Groups: White and Black AfricanMultiple Ethnic Groups: White and Black CaribbeanMultiple Ethnic Groups: OtherWhite: BritishWhite: Gypsy or Irish TravellerWhite: IrishWhite: Other WhiteOther Ethnic Group: ArabOther Ethnic Group: Any Other Ethnic GroupPrefers Not to SayUnknown

Child's date of birth *

DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

What age group does your child fit into? *

• Pre-schools (2 – 4 years old)
• Play schemes (4 – 12 years old)
• Youth schemes (13 – 18 years old)

Which Challengers Preschool would you like to attend? *Farnham PreschoolGuildford Preschool

Which Challengers Playscheme would you like to attend? *Winchester PlayRichmond PlayEastleigh PlayFarnham PlayGuildford PlayKingston Play

Which Challengers Youthscheme would you like to attend? *Basingstoke YouthKingston YouthChichester YouthEastleigh YouthFarnham YouthGuildford YouthHavant YouthRichmond Youth

Your child's needs

Please tell us more about your child’s disability, special educational need, condition or impairment.

Please select your child's primary disability/impairment *Associated Challenging BehavioursAssociated Challenging BehavioursAttention Deficit Hyperactivity Disorder (ADHD)Autistic Spectrum Disorder (ASD)Cerebral PalsyDiabetesDown's SyndromeEmotional and Behavioural DisorderEpilepsyGlobal Development DelayHearing ImpairmentLearning DisabilitiesMental IllnessMultiple SclerosisMuscular DystrophyParalysisSpeech ImpairmentSpina BifidaVisual ImpairmentOther ImpairmentNo Impairment

Does your child have an additional disability/impairment *

• Yes
• No

Please select your child's secondary disability/impairment *Associated Challenging BehavioursAssociated Challenging BehavioursAttention Deficit Hyperactivity Disorder (ADHD)Autistic Spectrum Disorder (ASD)Cerebral PalsyDiabetesDown's SyndromeEmotional and Behavioural DisorderEpilepsyGlobal Development DelayHearing ImpairmentLearning DisabilitiesMental IllnessMultiple SclerosisMuscular DystrophyParalysisSpeech ImpairmentSpina BifidaVisual ImpairmentOther ImpairmentNo Impairment

What level of support do you think your child would need at Challengers? *

• One to one support from a staff member at all times
• Supervision from a staff member but not all the time
• Unsure

Social Workers and Other Professionals

Does your child have a Social Worker? *YesNo

What team is your Social Worker in? *

Are there any other professionals involved in your child's care? If so, please give us more details.

School

Please tell us about your child’s school arrangements.

What type of school does your child attend? *Mainstream SchoolSpecialist SEND SchoolHome EducatedNot in School

Other useful information

Does your child have an Education and Health Care Plan (EHCP)? *YesNo

What is your child's Gateway Card number?

For Hampshire residents only

Photo and film permissions

We regularly take photos and videos at our Play and Youth schemes. These are used on our website, in printed documents and across our social media channels.

Photo permission *

• True
• False

I am happy for Challengers to take photos of my child

Film permission *

• True
• False

I am happy for Challengers to take video footage of my child

Submit