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 give consentI do not give consent
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 give consentI do not give consent
I give consentI do not give consent
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.
YesNo
Name of voucher *
Yes, I have read and, in submitting this form, accept the above conditions for my child attending Breakfast and Teatime club.No.
Parent/Carers Signature*

Clear
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