"*" indicates required fields Step 1 of 12 – Start 8% FacebookThis field is for validation purposes and should be left unchanged.Why register?If you have a child or children under 5 and would like to join our sessions, register here and we will send you relevant information. Please do contact us if you have any queries.This field is hidden when viewing the formWhich type(s) of activity are you interested in?* In-person parent and toddler groups Online sessions on Zoom Events Other activities Friends of Daniel’s Den This field is hidden when viewing the formWould you like to become a "Friend of Daniel's Den"?*Friends help us with raising funds, and we keep in touch with them regularly about our activities. Yes please No thank you That’s great! Please tick “Friends of Daniel’s Den” in the “Interests” question above, and we’ll be in touch. The “Next” button will appear below when you’ve done this. ChildrenHow many children would you like to register?*This form can take up to three children. Please fill in another form if you have more.Please enter a number from 1 to 3. First childFirst child's name* First name Surname Date of birth* Day Month Year Gender* Female Male Does your child have any medical conditions, disability or special needs?* Yes No Please give brief details*All information will be held securely and used to help you and your child within sessions. We can also help you both to access local services if needed.Religion (optional)AnglicanBaptistBuddhistChristianHinduJudaismMethodistMuslimRoman CatholicSikhUnited Reform ChurchNo ReligionOtherEthnicity (optional)IndianPakistaniBangladeshiChineseAny other Asian backgroundCaribbeanAfricanAny other Black, Black British, or Caribbean backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed or multiple ethnic backgroundEnglish, Welsh, Scottish, Northern Irish or BritishIrishAny other White backgroundArabAny other ethnic groupOther Second childSecond child's name* First name Surname Date of birth* Day Month Year Gender* Female Male Does your child have any medical conditions, disability or special needs?* Yes No Please give brief details*All information will be held securely and used to help you and your child within sessions. We can also help you both to access local services if needed.Religion (optional)AnglicanBaptistBuddhistChristianHinduJudaismMethodistMuslimRoman CatholicSikhUnited Reform ChurchNo ReligionEthnicity (optional)IndianPakistaniBangladeshiChineseAny other Asian backgroundCaribbeanAfricanAny other Black, Black British, or Caribbean backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed or multiple ethnic backgroundEnglish, Welsh, Scottish, Northern Irish or BritishIrishAny other White backgroundArabAny other ethnic groupOther Third childThird child's name* First name Surname Date of birth* Day Month Year Gender* Female Male Does your child have any medical conditions, disability or special needs?* Yes No Please give brief details*All information will be held securely and used to help you and your child within sessions. We can also help you both to access local services if needed.Religion (optional)AnglicanBaptistBuddhistChristianHinduJudaismMethodistMuslimRoman CatholicSikhUnited Reform ChurchNo ReligionEthnicity (optional)IndianPakistaniBangladeshiChineseAny other Asian backgroundCaribbeanAfricanAny other Black, Black British, or Caribbean backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed or multiple ethnic backgroundEnglish, Welsh, Scottish, Northern Irish or BritishIrishAny other White backgroundArabAny other ethnic groupOther How many responsible adults would you like to register?Please register a parent and any adult who will be bringing children to a session.Please enter a number from 1 to 3. Responsible adultAdult's name* First name Surname Adult's gender* Female Male What is your relationship to the child/ren you're registering?* Parent Grandparent Aunt or uncle Sibling Childminder or nanny Au pair Foster carer Other relative Are you their legal parent or guardian?* Yes No Please do continue, but also arrange for the legal parent or guardian of each child to fill in this registration form as soon as possible. Thank you!Contact detailsWe’ll use your phone number and email address to keep you informed of updates or last-minute session changes. Thank you, and remember you can withdraw your consent for contact at any time.Address* Address line 1 Address Line 2 City or town Borough Postcode Email address*We need at least an email address to keep you informed. If this is a problem for you, please get in touch. Mobile phone number (optional)Home phone number (optional)This field is hidden when viewing the formContact preferences Email Direct emails Phone Mobile phone Direct Mail SMS Second responsible adultNote: you must have permission from this person to provide their details. Once you’ve done this, they will not need to register separately with Daniel’s Den if they chose to attend any activities.Second adult's name* First name Surname Second adult's gender* Female Male What is the second adult's relationship to the child/ren you're registering?* Parent Grandparent Aunt or uncle Sibling Childminder or nanny Au pair Foster carer Other relative Is the second adult their legal parent or guardian?* Yes No Second adult's contact detailsWe’ll use your phone number and email address to keep you informed of updates or last-minute session changes. Thank you, and remember you can withdraw your consent for contact at any time.Second adult's address* Address line 1 Address Line 2 City or town Borough Postcode Second adult's email address*We need at least an email address to keep you informed. If this is a problem for you, please get in touch. Second adult's mobile phone number (optional)Second adult's home phone number (optional)This field is hidden when viewing the formSecond adult's contact preferences Email Direct emails Phone Mobile phone Direct Mail SMS Third responsible adultNote: you must have permission from this person to provide their details. Once you’ve done this, they will not need to register separately with Daniel’s Den if they chose to attend any activities.Third adult's name* First name Surname Third adult's gender* Female Male What is the third adult's relationship to the child/ren you're registering?* Parent Grandparent Aunt or uncle Sibling Childminder or nanny Au pair Foster carer Other relative Is the third adult their legal parent or guardian?* Yes No Third adult's contact detailsWe’ll use your phone number and email address to keep you informed of updates or last-minute session changes. Thank you, and remember you can withdraw your consent for contact at any time.Third adult's address* Address line 1 Address Line 2 City or town Borough Postcode Third adult's email address*We need at least an email address to keep you informed. If this is a problem for you, please get in touch. Third adult's mobile phone number (optional)Third adult's home phone number (optional)This field is hidden when viewing the formThird adult's contact preferences Email Direct emails Phone Mobile phone Direct Mail SMS Emergency contactsIf you would like to, please provide us details of someone we can contact in the event of an emergency. This is not required to register or attend sessions.Emergency contact's namePlease put your contact’s name here, so we can be sure we are contacting the right person.Emergency contact phone numberEmergency contact alternative phone number(if they have more than one)Emergency contact consentThe person I name here has given me permission to share their details with Daniel’s Den, to be stored in accordance with Daniel’s Den’s privacy policy, and used to contact them in an emergency. The named person has agreed to thisRelationship to you(Spouse/Partner/Mother/Sister/Friend) Can you please tell us…How did you find out about Daniel's Den?ChurchFriendHealth VisitorInternetNewsletterSchoolSignWord of MouthPrevious attendanceConsentsPlease tell us whether you consent to each of the items below.Photos and video (optional)I give permission for photos and video to be taken that include me or my child or children, and used for publicity of Daniel’s Den and as a record of their activities. This may include publication on social media (Facebook, Twitter, etc) and the website. I agreeData protection*Daniel’s Den only maintain your details to help us understand who is using Daniel’s Den and plan services. You have the right to request a copy of all personal information about you held by us. You also have the right to request any errors be corrected. If any information that you have provided to us changes, please let a member of the Daniel’s Den team know. Your personal data will be stored on a secure database that is only accessible by authorised people with a controlled login. Daniel’s Den may share your information between staff and the partners we work with (e.g. hosts of venues we are based in.) Information will also be shared with third parties if there is a legal requirement to do so or if there is a risk of serious harm or threat to life. Consent can be withdrawn at any time, but this may affect your ability to access our services. For more information, see our Privacy Policy. I agree to my data being used as detailed aboveAnything else we should be aware of? This field is hidden when viewing the formVirtual sessionsThis field is hidden when viewing the formAre you interested in attending sessions online when it is not possible to meet in person?* Yes No This field is hidden when viewing the formVirtual sessions consentWe’re delighted that you’d like to join us online. We’ve written a simple code of conduct below to outline our expectations and ensure the online sessions run safely. Everyone who attends the sessions needs to read and agree to it, and unfortunately anyone violating this agreement may need to be removed from the session and/or banned in future. Thank you!This field is hidden when viewing the formJoining an online session*Sessions will be on Zoom, which you will need to download beforehand. You will need to click the link we send you or enter the meeting ID, and then the password. You mustn’t share the meeting details with anyone who is not registered. If a friend or family member would like to join, please ask them to register via the website first. When joining, please use your first or preferred name, not a nickname or other username like “FunnyBunnysMum”. I agree to all the aboveThis field is hidden when viewing the formDuring an online session*Please be patient if we experience technical difficulties or if it is sometimes harder to hear or understand what people are saying. In busy sessions or if we are sharing important information, we may mute you or ask you to mute yourself, to reduce background noise so everyone can hear. If you’re using two or more devices in one household, please keep them in separate rooms, to avoid distorted sound. We suggest you use the “thumbs-up” reaction in Zoom if you agree with what is being said, and the “clap” reaction as a hands-up when you are trying to say something, so that in busy meetings we avoid everyone talking over each other. Be aware of your surroundings and background sounds (like someone going to the loo in the next room!) Sessions do time out automatically, so although you are welcome to join at any time, once the scheduled time has finished it will end, whether we have all said goodbye or not. I am aware of the aboveSafeguarding*Please be respectful of each other and our Daniel’s Den volunteers, using kind language and being prepared to listen to others. DO NOT record or take photos of anything without others’ consent. Please do not share any other media during the session. I have read and agree to the aboveWhat happens next?You’re nearly there! Once you submit this form, we will be in touch soon by email to provide details of how you can join in with our sessions, either in person or digitally. There is no obligation to join any particular type of session. We look forward to seeing you soon!This field is hidden when viewing the formDate form submitted DD dot MM dot YYYY This field is hidden when viewing the formSummary of relationshipsThese fields are just text representations of earlier answers, for putting into Beacon. They are populated by custom code in the “Daniels Den Tweaks” plugin.This field is hidden when viewing the formFirst adult's relationshipsThis field is hidden when viewing the formSecond adult's relationshipsThis field is hidden when viewing the formThird adult's relationshipsThis field is hidden when viewing the formChildren's relationshipsThis field is hidden when viewing the formPost Custom Field
