Holiday Club Admission/Booking Form

Holiday Club - Medical/Contact Form

The information contained in this form will be treated as confidential and used by The Lenches Pre-school management team only. If you require any help completing this form, please contact the Manager.
PRIVACY NOTICE

The Lenches Pre-school values the privacy of all children and their families and want to be clear about the data collected and processed.

Our Privacy Policy complies with current GDPR and is available on request.

The Lenches Pre-school respect yours and your child's personal data. Any information you provide will not be sold to any third party.
Child's Details:
Full Name (Child)

First Name/sMiddle Name/sLast Name
Date of Birth (Child)

DayMonthYear
Date

Emergency Contact Details:

Please provide details of who to contact in an emergency (in order of who is to be contacted first).

Please keep all information up to date. It is the responsibility of Parents/Carers to inform The Lenches Pre-school of any changes in relation to the child.
1st Contact Name

First Name/sLast Name
Phone number 1
Phone number 2
Relationship to child
2nd Contact Name

First Name/sLast Name
Phone number 1
Phone number 2
Relationship to child

Parent/Carer details:

Please provide details of who has legal parental/carer responsibility for the child.

Each person you name has the right to recieve reports, newsletters and other information related to the child.

Please keep all information up to date. It is the responsibility of Parents/Carers to inform The Lenches Pre-school of any changes in relation to the child.
Full Name (Parent/Carer 1)

Mr/Mrs/Ms etc.First Name/sMiddle Name/sLast Name
Home Address (Parent/Carer)

House number/name

Street Address

City/TownCounty

Post Code
Phone number 1
Phone number 2
Relationship to child
Email
Full Name (Parent/Carer 2)

Mr/Mrs/Ms etc.First Name/sMiddle Name/sLast Name
Home Address (Parent/Carer)

House number/name

Street Address

City/TownCounty

Post Code
Phone number 1
Phone number 2
Relationship to child
Email
Collection Authorisation

If a child is to be collected by someone else other than legal parent/guardian named on this form, you must complete the following authorisation. We will ask you to provide photographic ID and the person collecting will need a password when collecting the child if unknown to the staff members. Please let the staff know daily should someone else other than you be collecting.
Name (Person collecting child other than parent/carer)

First Name/sLast Name
Relationship to child
Upload File
Please provide a unique confidential password for use in the event of any person requested to collect your child other than those with Parental responsibility as named above.

Consents

Please keep all information up to date. It is the responsibility of Parents/Carers to inform The Lenches Pre-school of any changes in relation to your child.
Medical Consent

The Lenches Pre-School may need to administer first aid/medication to your child during Pre-school hours.
I acknowledge The Lenches Pre-school may need to administer necessary first aid to my child whilst they are at Pre-school such as plasters, cold compresses etc, administer prescribed medication (i.e. inhaler, antibiotics, Epi-Pen) or access emergency medical treatment from a doctor or emergency services.*

I have read and understand this statement
Information Sharing

The Lenches Pre-School have a duty of care to share details of any child or family if there are any concerns about a child's development, health, well-being or safeguarding.
I acknowledge in order to support my Child's development, learning and/or safeguarding The Lenches Pre-school may need to contact and provide details about my child or family to relevant third parties, such as health care workers/visitors, Worcestershire Children First, interventions teams and speech and language etc.*

I have read and understand this statement
Authorisation and form submission
By submitting this form I confirm that I have read and understand this form in its entirety and understand what is being asked of me. I also confirm I have provided The Lenches Pre-school with all relevant information and that the information I have provided is true and accurate to the best of my knowledge and understanding.*

I have read and understand this statement
Name of person completing this form

First NameLast Name
Relationship to child
Today's Date*
Should be Empty:

Holiday Club - Medical/Contact Form

Collection Authorisation

Medical and Health Information

Consents

Medical Consent

Information Sharing

Authorisation and form submission