Xtra Time Holywell - Registration Form

Xtra Time Kidz Club

Holywell

Registration Form (2024/2025)

Please complete and submit the Registration Form below prior to booking any childcare services (including Breakfast and After School Clubs).

Have you ever completed Registration Form?*

YesNo

Irrespective of your child attending Xtra Time Wrap Around Care in the past, this registration form must be completed every academic year for each child to ensure we have the most up to date information.

*Please note: This registration form is valid for the 2024/2025 academy year. Ensure you have a current picture of your child before completing this form.

Child's Full Name*

First NameLast Name

Child's School:*

Child's Class:*

Child's Year:*

Name Known As:

Date of Birth:*

DayMonthYear

Gender*

It is an Ofsted requirement for Xtra Time to have a current photo of your child (for our records only) - Please provide a photo of your child:*

Parent 1: Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal Code

Relationship to child: *

Parent 1:Mobile Phone Number*

Mobile number

Parent 1: E-mail*

example@example.com

Does this parent have parental legal responsibility*

YesNo

Parent 2: Name*

First NameLast Name

Parent 2: Mobile phone number*

Mobile number

Relationship to child: *

Does this parent have parental legal responsibility?*

YesNo

Does the child have a parent that they do not live with?

YesNo

Parent's Name

First NameLast Name

Relationship to child:

Address

Street Address

Street Address Line 2

City

Postal Code

Parent's Mobile phone number

Mobile number

Does this parent have parental legal responsibility?

YesNo

Contact 1: Name*

First NameLast Name

Emergency Contact 1:*

Mobile number

Relationship to child: *

Contact 2: Name*

First NameLast Name

Emergency Contact 2:*

Mobile number

Relationship to child: *

What is the main language your child speaks?*

What is the main language your child speaks if not English?

What is the main religion in your family?

Are there any festivals or special occasions celebrated in your culture that your child will be taking part in and that you would like to see acknowledged and celebrated whilst he/she is in our setting?

Will your child require any special support whilst in our setting? For example: Communication, toileting, mobility etc. Please share any strategies or methods that have proven effective:

Does your child have any allergies or medical conditions?*

Does your child have any of the following medical conditions?*

If your child any medical condition(s) that are not listed above? Please provide details in the box below:

Does your child need to regularly take medicine*

YesNo

Please provide details of the medicines your child takes:

Please provide details of any allergies your child has:

Please provide details of any dietary needs or preferences:*

Does your child have Special Educational Needs?*

YesNo

Please provide details of SEN requirements:*

At Xtra Time we want your child to always be safe, however on occasions children can sustain injuries. In these situations we may need to provide first aid teatment for your child. Please confirm what treatment you consent to us providing when appropriate. Where your child needs treatment, this will be always be carried out by a qualified First Aider.

Cuts/graze - cleaned and plaster or dressing applied:*

Ice packs used to treat minor injuries: *

I give consent for Xtra Time staff to help apply suncream to my child in hot weather?*

Whilst every attempt will be made to contact you or your emergency contact in the event of a medical emergency, if we are unsuccessful, your permission is required to take any appropriate action, including taking the child to hospital to receive the appropriate treatment:*

I give permission for routine observations and assessments to be carried out by Xtra Time staff in line with EYFS Requirements, and to share information with the school as appropriate. This includes taking photographs:*

I give permission for Xtra Time staff to take photographs of my child which will only be used for recording events at Xtra Time Kidz Club:*

I give permission for Xtra Time staff to escort my child/children between the school premises and Xtra Time Kidz Club in line with the Xtra Time’s collection policy:*

I give permission for my child’s photo being used in displays for Xtra Time Kidz Club’s provision and any media that is linked with Xtra Time:*

Registration Fee:

Registration Fee £29.99

Registration Form Payment

Please can we ask all parents / carers to make a manual bank transfer of £29.99 to the provision's account below using Reference: 'RegForm' and then your child's name.

Xtra Time Holywell - Sort Code: 090129 - Account Number: 14404081

It is soley the parent/carers responsibilty to make the booking payment in full. If your child's payment has not been made in full to the account specified above, we cannot secure your child's booking.

Once you have made your payment in full, please include your payment reference and payment date below.

ALL PAYMENTS MUST ONLY BE PAID INTO THE ACCOUNTS LISTED ABOVE AS EACH XTRA TIME SERVICE HAS ITS OWN SPECIFIED ACCOUNT. THIS HELPS US TO ALLOCATE YOUR PAYMENT. IF YOUR PAYING BY CHILDCARE VOUCHERS AND YOUR PROVIDER IS NOT LISTED ABOVE PLEASE CONTACT US.

When making a payment, please use the following reference: XTHolywell - Child's Name.

Payment Date:*

XTHolywell - Child's Name

Payment Date:*

Payment Date

Please attach a screenshot of your payment below.*

If you are unable to attach a screenshot of your payment, please write the details of your payment on a piece of paper stating the reference, date and amount paid. Providing this enables our finance team to easily find your payment and avoid the need to contact you. Please do not contact us to confirm if your payment has been made. We will contact you if there are any issues with your payment. Your submission of this form and confirmation email is confirmation of your booking.

Do you follow us on social media?*

YesNo

Thank you for following us on social media.

Please Like, Share and Subscribe to our social media platforms by clicking on to the images below.

Additional Comments:

Any additional information. For example details about a manual payment such as payment amount, reference and date.

I have completed this booking form as honestly and accurately as possible, I understand that Xtra Time Kidz Club/1st Touch Coaching can only provide the best service based upon the information I provide. If my child has any special requirements, for example toileting or SEN. I have added this information in the additional comments section above.*

I Agree

Once the submit button has been clicked your registration form is being processed, please do not click the submit button more than once otherwise you will create a duplicate booking and get charged twice. Duplicate bookings and payments being charged twice are solely down to the Booker clicking the submit button more than once, all fees incurred for processing a refund will be payable by the person who made the booking. To avoid any inconvenience, please be patient while your registration form is being processed.*

I Agree

As the parent/guardian of the child named above, I confirm by signing below the information I have given is correct to the best of my knowledge. I consent to Xtra Time Kidz Club taking my child/children onto the field, playground, AstroTurf and in and around the Xtra Time Kidz Club site. I understand that I am committing to a minimum of half a term and that I will give two weeks notice of my intention to withdraw my child from any sessions. I agree to pay in full, 5 days into each new term for sessions my child attends during the forthcoming school term. I understand that no credit will be given for sessions not taken due to illness, holiday or other occasions. It is my responsibility to inform Xtra Time Kidz Club of any changes to the information provided above for my child immediately.*

Yes - please sign in the white box below:

Please sign below before clicking the 'Submit' button below: *

Name of Parent(s) with Whom Child Lives

Name of Parent(s) with Whom the child does NOT live with

Other Emergency Contact Details

Additional Details