Oakley Wraparound Registration
Breakfast Club & Sunset Club are run by Oakley Pre-school CIO
Child's Details:
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parent/Carer 1 (Registering Parent/Carer)
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Relationship to Child
*
Place of Work
Work Telephone Number (if different to above)
Please enter a valid phone number.
Do you have Parental Responsibility for the child?
*
Yes
No
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Parent/Carer 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address (if different to child)
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Relationship to Child
Place of Work
Work Telephone Number (if different to above)
Please enter a valid phone number.
Does this individual have Parental Responsibility for the child?
Yes
No
Is Pre-school authorised to release the child into the care of this individual?
Yes
No
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Emergency Contacts
To be used as an alternative if Parents/Carers are unavailable in an emergency.
Emergency Contact 1:
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Child
*
Is Pre-school authorised to release the child into the care of this individual?
*
Yes
No
Emergency Contact 2:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship to Child
Is Pre-school authorised to release the child into the care of this individual?
Yes
No
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Permission to Collect from Sunset Club
OPTIONAL: Please list anyone else you would like to give permission to collect your child from Sunset Club
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Is Pre-school authorised to release the child into the care of this individual?
Yes
No
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Is Pre-school authorised to release the child into the care of this individual?
Yes
No
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Walking to and from Wraparound alone.
Oakley Pre-school CIO have made the decision to only allow children in Year 5 or Year 6 to walk home alone, and then only with the permission of parents. If permission is granted, children will only be released at the end of the booked session, and no earlier.
Oakley Pre-school accepts no responsibility for children's safety until they enter through the gate and are signed in. This includes in the situation where a family chooses for the child to walk to Breakfast Club alone.
*
I understand that my child's safe arrival at Pre-school is my responsibility, including in the situation where my child walks to Breakfast Club alone.
Do you give your child permission to walk home alone from Sunset Club?
*
Yes
No
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Support Services
Is your child subject to any court orders? If yes, please provide more information & a copy of the court order in confidence to preschoolmanager@oakley.bucks.sch.uk.
*
Yes
No
Is your child or family under the support of Social Services, or Family Support Services/Early Help?
*
Yes
No
If yes, please provide more details here.
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Medical Information
In addition to the information below, please bring your child's medical record (Red Book) into Pre-school before their first settling in session.
Doctor's Name & Surgery Address
*
Doctor's Phone Number
*
Please enter a valid phone number.
Health Visitor Name/Details
*
Health Visitor Phone Number
*
Please enter a valid phone number.
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Care information
If your child has any of the below medical conditions and/or care needs, please provide details below.
Allergies
Asthma/Eczema
Special Dietary Needs
Other medical or care needs Pre-school should be aware of:
Is your child being seen by any of the below specialist services?
*
Yes
No
Audiologist
Community Paediatrician
Physiotherapist
Dietician
Health Visitor
Speech Therapist
Orthoptist
Occupational Therapist
Psychologist
Other
If other, please provide details
If yes to any of the above specialist service support, please provide details of their involvement, last appointment date and any treatment plan.
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Consents
Information Sharing
Yes
No
I give consent for Oakley Pre-school to share information with specialists supporting my child or family
I give consent for Oakley Pre-school to share relevant and necessary information with Oakley School.
I give consent for Oakley Pre-school to share my and my child's data with third party systems (e.g. Xero for invoicing, Tapestry for information about my child's day and Funding Loop for funding)
Medications
Yes
No
I give permission for my child to be administered any non prescribed medication when needed (e.g. Pirition for allergic reaction or Calpol for pain)
I give permission for my child to have adhesive plasters applied if necessary for first aid purposes
I give permission for Pre-school to seek urgent medical attention for my child if required, and in particular in the event of Pre-school being unable to contact me.
Nut Free Environment
Yes
No
I understand that Oakley Pre-school is a Nut Free Environment and agree to abide by this policy (including checking ingredients of packaged food sent in).
Photographs and Development Observations
Yes
No
I give permission for photographs of my child to be published as part of Pre-school's advertising (including but not limited to the Pre-school website, Facebook, Instagram, posters & prospectus).
Communications
Yes
No
I agree to be added to the Pre-school email list, through which my email address may be visible to other parents.
I understand it is my responsibility to join the Wraparound WhatsApp Announcements group.
Trips out of Pre-school
Yes
No
I give permission for my child to take part in visits and walks within Oakley.
Policies (including Admissions & Fees policy)
Yes
No
I understand that all Policies & Procedures are available at www.oakleypreschool.co.uk/policies-and-procedures using the password HappyChildren
I have read and accept the Wrapround Admissions & Fee Policy valid on today's date
I agree that I will pay for Wraparound services on receipt of invoice
Volunteer Committee
Yes
No
I understand that Oakley Pre-school is a charity, and that on registration for Wraparound care my family become Members of Oakley Pre-school CIO.
I understand that as part of the charity structure, Pre-school is led by a volunteer committee & I agree to help and support the committee where I can.
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Final Declarations:
I confirm that all the information provided within this Registration Form is true and correct.
*
Name
*
First Name
Last Name
Date
*
-
Day
-
Month
Year
Date
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