schools out Registration Form

Shapelindley running Schools out holiday programme for Kirklees Council funded by the DFE

Child's Full Name*

Child's First NameChild's Last Name

Child's Date of Birth *

For Example 28/12/1999

School that child currently attends*

Gender of child at birth*

MaleFemale

Parent/Carer Full Name*

Parent/Carer First NameParnet Carer Last Name

Parent/Carer Contact Number*

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 familyNo. I am not eligible for benefits related Free School Meals for my family

Child's Address*

Door Number /House Name

Street Address

City

Child's Post Code

Person/s responsible for picking up child

Emergency Contact Number*

Please enter a valid phone number.

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?*

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 consentI 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)