Shapelindley
running Schools out holiday programme for Kirklees Council funded by the DFE
schools out Registration Form
Healthy Holidays and Food programme
Child's Full Name
*
Child's First Name
Child's Last Name
Child's Date of Birth
*
/
Day
/
Month
Year
For Example 28/12/1999
School that child currently attends
*
Gender of child at birth
*
Male
Female
Parent/Carer Full Name
*
Parent/Carer First Name
Parnet Carer Last Name
Parent/Carer Contact Number
*
Format: 00000-000000.
Parent /Carer E-mail
*
example@example.com
Eligibility for Benefits Related Free School Meals
*
Yes. I am eligible for benefits related Free School Meals for my family
No. I am not eligible for benefits related Free School Meals for my family
Child's Address
*
Door Number /House Name
Street Address
City
State / Province
Child's Post Code
Person/s responsible for picking up child
Emergency Contact Number
*
Please enter a valid phone number.
Format: 00000-000000.
Doctors Name & Surgery Address
*
Are there any known special dietary requirements? (please state if Halal only diet or vegetarian only diet)
*
How did you hear about us?
*
E flyer
School Newsletter
Neighbour/friend
Teacher
Other
Please Specify
Is your child living with anything that would indicate the need for additional support whilst attending our sessions. Do they have a My Support Plan/EHCP/ a support worker involved with the family?
*
Due to the sensitive nature of this question it is viewed as confidential
Is there anything else we should know about your child that you have not already told us about?
Arrangements in the case of sickness and/or any emergency: We do not accept children who have been sick or unwell in the last 48 hours of showing symptoms. We also expect parents/carers to please inform us 24 hours in advance if their child will not be attending. If a child becomes unwell during their stay with us we will contact the parent/carer at the earliest opportunity. You are then required to immediately collect/make arrangements to have your child collected. Staff at Shapelindley C.I.C. have undertaken appropriate training to deal with an emergency. While every attempt will be made to contact you, there may be a situation when it is deemed necessary to; administer basic first aid to your child (of which a written record will be kept) and in an emergency, call the emergency services. Please tick below giving your consent to Shapelindley C.I.C. taking such action in your absence:
*
I give consent
I don't give consent
Pictures and Videos may be taken during the day of children enjoying themselves. We may be asked to share this information for evaluation purposes of our provision and service delivery with the council (our funders). Further to this we may want to use some of the images for our website or publications. no names or personal details will be attributed to any media that we use. We are registered data handlers and have a GDPR policy.
*
I give consent for Shape to use Images from theses sessions for their own website and publications.
I don't give consent for Shape to use Images from theses sessions for their own website and publications.
Select Sessions from Tues 2 Jan 2024 (9 am -1pm)
Select Sessions Wed 3 Jan 2024 (9 am -1pm)
Select Sessions Thur 4 Jan.2024 (9 am -1pm)
Select Sessions Fri 5 Jan.2024 (9 am -1pm)
Submit
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