Registration Form Out of Hours School Provision

Parent/carer's name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number*
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Email*
example@example.com
Are you considered a Critical Worker? If yes, please provide details*
e.g. NHS staff
Is the child normally resident with this parent/carer?*

YesNo
We will use your email address to contact you concerning important Preschool information and to communicate our termly newsletter. Can you please confirm that you are happy for us to do this:*

YesNo
Parent/carer's name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number*
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Email*
example@example.com
Are you considered a Critical Worker? If yes, please provide details*
e.g. NHS staff
Is the child normally resident with this parent/carer?*

YesNo
We will use your email address to contact you concerning important Preschool information and to communicate our termly newsletter. Can you please confirm that you are happy for us to do this:*

YesNo

EDUCATIONAL AND INFORMATION SHARING
Because of the need to take your child to and from school by “walking bus”, we are only able to offer “Out of School Provision” for pupils attending The Duchy School, Bowley Meadow, Hele Road, Bradninch EX5 4RF.

In order to ensure your child's safety, please can you sign to agree to us sharing information with The Duchy School. (It is also important that you advise both us (01392 881975) and the school (01392 881482) if your child is absent from school on a day they would normally take Out of School Provision sessions. You must also notify both us and the school if you intend to drop them at school or collect them from school yourself.)

Please sign to authorise sharing of information with your child's school, and to confirm that you will notify both us and the school daily, in the event of absence or a change in the collection arrangements.
Signature - authorise sharing of information.*

Clear
SHARING INFORMATION WITHOUT CONSENT
We are obliged to share confidential information without authorisation from the person who provided it, or to whom it relates, if it is in the public interest. That is when:
- it is to prevent a crime from being committed or to intervene where one may have been, or to prevent harm to a child or adult; or
- not sharing it could be worse than the outcome of having shared it.
Please refer to our Information Sharing Policy for further information.

Please sign to confirm you understand the circumstances in which information may be shared without your consent. This will only be when it is a matter of safeguarding a child or vulnerable adult;
Signature - sharing information without consent*

Clear

COLLECTION AND CONTACT DETAILS:

Name(s) of any person(s) (other than those with parental responsibility) authorised to collect your child from pre-school. Please also get them to sign the separate collection authority sheet, which we will provide on request:*

	Name of person authorised to collect your child.	Telephone No.
1
2
3
4
5
6

Please notify us of any changes to collection arrangements– in particular please notify us daily if your child is going home with another parent. We will enter the details into the collection book. No child will be released to an unauthorised person.
Emergency Contacts

In the event of an emergency where we cannot reach either parent/carer, please provide two additional emergency contacts;
Name of Emergency Contact 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Relationship to child:*
Phone Number*
Please enter a valid phone number.
Mobile Number*
Please enter a valid phone number.
Name of Emergency Contact 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Relationship to child:*
Phone Number*
Please enter a valid phone number.
Mobile Number*
Please enter a valid phone number.

LANGUAGE, CULTURE & ETHNICITY
Child’s first language:*
Other languages spoken at home:*
Child's Ethnicity:*
We have an Equality and Diversity Policy, and an Inclusion Policy, and we are keen to support and share cultural differences with our children. Does your child have any cultural, religious, language or ethnic background you would like us to know about? *
Please enter any background information on your child which you feel may help us to understand him or her – for example, any relevant home experiences or special interests, any brothers or sisters, pets, any special words (for example for the toilet), any recent family events which have affected the child:*
This information will be kept strictly confidential.

HELP US TO HELP YOUR CHILD
The Duchy Preschool and playgroup is a charity which relies on voluntary help from parents to maintain a high standard of provision. Please indicate if you are able to help in any of the following ways?

Fund-raisingAdministrationDramaComputer workSewingMusicArts/craftsOther
New committee members are always welcome; please ask for details.
PRIVACY STATEMENT – GENERAL DATA PROTECTION REGULATION (GDPR)
We, Duchy Preschool and Playgroup (a Charitable Incorporated Organisation registered in England and Wales charity number 1157005, registered office Millway, Bradninch, Devon EX5 4NL) are the Data Controller for the purposes of the GDPR. We collect information from you and may receive information from other groups (such as other early years settings, schools and/or baby and toddler groups as authorised by you). We hold this personal data about you and your child(ren) and use it to:
- Support the development and wellbeing of your child
- Monitor and report on the progress of your child
- Provide appropriate pastoral care to you and your child
- Access free entitlement funding for your child
- Manage invoicing and receivables for sessions we are permitted to charge for
- Assess how well we are performing as an Early Years Setting
- To contact you to inform you about your child, or to inform you about important Preschool information and events
The information we hold includes:
- Your contact details and details of other emergency contacts you give to us
- Sessions booked for your child and attendance information
- Information about your child's development
- Characteristics such as ethnic group
- Special educational needs
- Relevant medical information
We will not give information about you or your child to anyone outside Duchy Preschool and Playgroup without your consent unless the law and our policies require and permit it. We are required to pass some of your information to the Local Authority (Devon County Council) and may be required to share information with other bodies. Information we hold about you will be kept secure, either by using locked storage for information on paper, or by using encrypted storage for electronic information.

If you want to see a copy of the information that we hold and share on you or your child please ask the person responsible for data protection, our Manager Naomi Lee.

You can find the scope of our registration with the Information Commissioners Office at http://www.ico.org.uk/. Our registration number is ZA197054.

FINALLY, IT WOULD BE VERY HELPFUL IF YOU COULD LET US KNOW HOW YOU HEARD ABOUT US:
CONFIRMATION OF APPLICATION
I confirm my application for a place for my child name of child* (name of child) for Out of School Provision (provided by Duchy Preschool and Playgroup at the playgroup site) as detailed above.
I understand that the Breakfast Session starts at 08:00 and that Preschool Walking Bus in the morning will leave for The Duchy School promptly at 08:30. I understand that if I take breakfast sessions for my child I will be responsible for ensuring that my child has breakfast if I do not get my child to the Preschool until after 08:10, and also that Duchy Preschool and Playgroup will not be responsible for getting my child to school if I deliver them to the Preschool after the Walking Bus has departed. I also understand that no child will be allowed to join (or leave) the walking bus while it is “en route.” (Please also see the declaration on information sharing above)

I understand that by signing this application I am agreeing to comply with the terms and conditions of Duchy Preschool and Playgroup, including the billing policy. I also confirm that I will read the Pre-school's policies on the website www.duchypreschool.org (or that I will ask for a copy of the policies to be loaned to me as appropriate). (Please note that all persons having parental responsibility should sign unless they are not normally resident with the child. Please also note that we cannot accept applications unless they are signed.)
Name*

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Date
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
If you have any questions about us or this form please write to us or contact us on:

Duchy Pre-school & Playgroup,

Millway, Bradninch, Exeter EX5 4NL

Telephone: 01392 881975

email: admin@duchypreschool.org.uk

Our Website is at:

www.duchypreschool.org.uk

Permission to take your child’s photo – Terms and Conditions

1. Your consent is valid for the period your child attends the Duchy Preschool. If you have given appropriate consent, some images of your child may be used after this time in publicity material and on the Preschool website. If you wish these images to be withdrawn after your child leaves the Preschool please contact us in writing.
2. Consent can be withdrawn at any time by contacting the Preschool in writing.
3. The images we take will be of activities that show the Preschool and children in a positive light. Images may also be taken of children in our breakfast and after-school club.
4. We may use group photographs or footage with very general labels e.g.
‘learning about nature’.
5. If we use photographs of individual children on the website or in publicity material, we will not use the name of that child in the accompanying text or photo caption. If we name a child in the text, we will not use a photograph of that child to accompany the article.
6. If a child has won an award and the parent would like the name of their child to
accompany their picture we will obtain explicit permission from the parent before
using the image.
7. We will make every effort to ensure that we do not allow images to be taken of any children for whom we do not have permission or who are ‘at risk’ or disallowed from having their photographs taken for legal or social reasons.
8. We will take all reasonable measures to ensure the images are used solely for the purposes for which they are intended and not passed on to any third party websites or publishers. However, we cannot guarantee this and take no responsibility for the way images are used by other websites or publishers or for any consequences arising from publication where images have been used without our consent.
Should be Empty:

	Early Session 7.45am - 8am	Breakfast Session 8am - start of school (including breakfast)	Afternoon Session 3.30pm - 5pm (including tea)	Late Session 5pm - 6pm
Monday
Tuesday
Wednesday
Thursday
Friday

Registration Form

HEALTH, MEDICAL & SPECIAL EDUCATIONAL NEEDS

GENERAL PARENTAL/CARER PERMISSIONS

EDUCATIONAL AND INFORMATION SHARING

SHARING INFORMATION WITHOUT CONSENT

COLLECTION AND CONTACT DETAILS:

LANGUAGE, CULTURE & ETHNICITY

SESSIONS & BILLING

Sessions you would like your child to attend:

HELP US TO HELP YOUR CHILD

PRIVACY STATEMENT – GENERAL DATA PROTECTION REGULATION (GDPR)

CONFIRMATION OF APPLICATION