Saturday Club Registration Form
Please select which Club is your child is Joining/registering
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Orchard Way
Britannia Road
How did you hear about Saturday Club?
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Full Name of Child/Young person
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First Name of child
Last Name of child
Date Of Birth
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/
Day
/
Month
Year
Date
Address
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Street Address
Street Address Line 2
Town
County
Postal Code
Gender
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Female
Male
Other
Prefer not to say
Nationality
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Ethnic Origin. Please tick the ethnic group to which you belong. It is essential that we have this information so that we can monitor the effectiveness of the projects equal opportunities policies and practices.
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African Heritage
Bangladeshi
Black
Black Caribbean Heritage
Black Other
Chinese
Indian
Mixed Origin
Pakistani
White European
White UK Heritage
White Other
Other
Religion (Optional)
Mother's/Carers Name
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First Name
Last Name
Mother's/ Carers Address if different from above
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Street Address
Street Address Line 2
Town
County
Postal code
Mothers/Carers Mobile number
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Join our Whatsapp Broadcast list, notifying you with updates about club changes and information, trips and new projects.
Yes
Mothers/Carers Email Address
example@example.com
Fathers/Carers Mobile Number
Please list all people who will be dropping off and collecting your child/young person? Staff should be immediately informed of any changes to this arrangement.
Emergency Contacts: Please give details of a person other than the child’s/Young persons parents/main carer who may be contacted in the event of an emergency, if the main parent/carer is not contactable for any reason.
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First Name
Last Name
Above Emergency Contact mobile/Landline number
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Does your child/young person have any allergies
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Yes
NO
If selected Yes for above allergies, please give full details (if details are not completed then this may delay your form process)
Does your child/young person have any health or dietary issues useful for the centre to be aware of?
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Yes
NO
If selected Yes for the above question. Please give full details
Does your child have any additional needs we should be aware of? such as learning needs, speech etc?
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Yes
No
If selected Yes for the above question. Please give full details
Is there anything else you think it is important that we know or understand about your child/young person? (e.g. fears, hospitalisation, any changes in family life, religious observance, bereavement, moving home etc…)?
Outings Please select, If the above named child may be taken on supervised outings in the care of Saturday Club Staff.
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Yes I agree
No I dont agree
We like to use photos of the children/young people for social media, displays around the Centre and in the publication of reports, leaflets, publicity materials, activities and send to local or international funders.
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Yes I give consent
No I dont give consent
Consent for Medical Treatment, Please select, if the named child/young person should require medical treatment, a member of the Centre staff may take him/her to the appropriate health centre/casualty department.
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Yes I agree
No I dont agree
General Consent for Data Use - I confirm that the above information is, to the best of my knowledge, correct, I accept all the terms and conditions of the Sunrise project and give my permission for this information to be used in a database for the Sunrise Multicultural Project.
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I confirm
ONCE REGISTERED - WE WILL CONTACT YOU TO DISCUSS YOUR CHILD'S START DATE
Data Protection Statement
Any information you provide will be used solely to compile Project statistics. From time to time information will be passed onto the Local Education Authority and to local or International funders. These statistics will not allow anyone to be identified.
Please verify that you are human
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Submit
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