Oulton Breakfast and Teatime Club Registration Form

Oulton Breakfast and Teatime Club Registration Form
Children's Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Parent/Carer Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Home Phone Number
Please enter a valid phone number.Format: 00000 000000.
Mobile Phone Number
Please enter a valid phone number.Format: 00000 000000.
Work Phone Number
Please enter a valid phone number.Format: 00000 000000.
Email
example@example.com
2nd Parent/Carer Name

First NameLast Name
Home Phone Number
Please enter a valid phone number.Format: 00000 000000.
Mobile Phone Number
Please enter a valid phone number.Format: 00000 000000.
Work Phone Number
Please enter a valid phone number.Format: 00000 000000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Other named adults who are permitted to collect your child from club
Password to be used by named adults who are unknown to club staff
Emergency Contacts
1st Emergency Contact Name

First NameLast Name
Relationship to Child
Emergency contact phone number
Please enter a valid phone number.Format: 00000 000000.
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
2nd Emergency Contact Name

First NameLast Name
Relationship to Child
Emergency contact phone number
Please enter a valid phone number.Format: 00000 000000.
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Please indicate below any existing medical conditions/allergies
For Example: Has Asthma, needs an inhaler or allergic to nuts
Any other information you feel may help us in caring for your child
For Example: Has special education needs or lacks confidence in new places
Consents Forms: Please note, you need to confirm your agreement and/or consent for the following paragraphs. If you do not agree to any of the following, school may contact you to discuss this further.
I consent to my child/ren attending this club. I understand that the club follows the school's policies and procedures and there are expectations and obligations relating to the conduct of myself and my child/ren and I agree to abide by them. I understand that failure to do so will mean that my child/ren will no longer be able to attend the club. Once my child/ren is received by the Club staff they will be in the care of the staff until collected and signed out by a ‘named’ responsible adult. I will pay promptly for sessions even when my child/ren does not attend.
I have read and understand the school rules for responsible Internet use, and give permission for my son/daughter to access the Internet. I agree that my son/daughter will abide by the rules at all times. I understand that the school will take all reasonable precautions to ensure pupils cannot access inappropriate materials. I understand that the school cannot be held responsible for the nature or content of materials accessed through the Internet. I agree that the school is not liable for any damages arising from use of the Internet facilities.
I agree to my child being photographed or videoed while taking part in the Club activities, and that the photographs or videos may be used in the School prospectus, newsletters, school website, advertising, local press releases and displays.
Payment Information
All payments will show on your Arbor account. This includes the one off registration fee £25 (new applicants only) late fees and any extra sessions.
Will you use any Childcare Vouchers?
Name of voucher
Please confirm that you have read the Wraparound Care terms and conditions, available on the school website.
Parent/Carers Signature
Date

DayMonthYear
Date
Should be Empty:

Oulton Breakfast and Teatime Club Registration Form

Emergency Contacts

Consents Forms: Please note, you need to confirm your agreement and/or consent for the following paragraphs. If you do not agree to any of the following, school may contact you to discuss this further.

Payment Information