Please print this form and send to the address below

SCOTTISH DISABLED MEMBERS SELF ORGANISED GROUP

ANNUAL FORUM

SATURDAY 15 DECEMBER 2005

STUC OFFICES, 333 WOODLANDS RD, GLASGOW G3 6NG

DELEGATES CRECHE REQUEST

NAME: ......................................................................................................

ADDRESS: ......................................................................................................

......................................................................................................

TEL. NO: ......................................................................................................

Please complete a separate form for each child

Name of Child

 

Age:

 

Gender:

 

® Are there any foods/drinks your child cannot eat/drink for medical, religious or other reasons? YES/NO

If 'YES', please give details

 

 

® Does your child have any access requirements? YES/NO

If 'YES', please give details

 

 

 

 

® Is your child toilet trained or wearing nappies?

 

® What is the best way to settle your child?

 

® Is there anything in particular we should know about your child so as to make their stay more pleasurable?

 

 

® Would you give permission to take your child on an outing?

YES/NO

NB ONLY CHILDREN UP TO THE AGE OF 16 YEARS CAN BE CONSIDERED ELIGIBLE FOR THE CRECHE

 

I hereby consent to receiving medical treatment eg plasters,

antiseptic cream, if creche workers and/or a doctor feels this to

be necessary.

 

SIGNATURE ............................................……….. DATE ........................

RELATIONSHIP TO CHILD ..................................................................…......

 

PLEASE COMPLETE AND RETURN TO EILEEN DINNING, SCOTTISH WOMEN'S OFFICER, UNISON HOUSE, 14 WEST CAMPBELL STREET, GLASGOW G2 6ER BY NO LATER FRIDAY 24 DECEMBER 2004.

 

 

Back to Forum menu