Registration Form

Child’s Name

First NameLast Name

Child’s Age

Child’s Date of Birth

Date

Child’s Gender

Parents/Guardians Name

First NameLast Name

Parents Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Post Code

Home Tel

Please enter a valid phone number.Format: 00000-000000.

Mobile Tel

Please enter a valid phone number.Format: 00000-000000.

Primary Email

example@example.com

Secondary Email

example@example.com

Which parent(s) does the child normally live with?

Who has legal responsibility for the child?

Who has legal contact with the child?

Sessions Required for Each Weekday AM/PM

Preferred Start Date

Date

Signature for Start Date Confirmation

Mother’s Work Phone

Please enter a valid phone number.Format: 00000-000000.

Mother’s Mobile Phone

Please enter a valid phone number.Format: 00000-000000.

Dad’s Work Phone

Please enter a valid phone number.Format: 00000-000000.

Dad’s Mobile Phone

Please enter a valid phone number.Format: 00000-000000.

Other Emergency Contact Name

Other Emergency Contact Relationship

Other Emergency Contact Phone

Please enter a valid phone number.Format: 00000-000000.

Doctor Name and Surgery Address

Doctor’s Phone Number

Please enter a valid phone number.Format: 00000-000000.

Health Visitor Name

Paediatrician Name

Special Educational Needs Co-ordinator Name

Dietician Name

Immunisation: Diphtheria

Immunisation: Whooping Cough

Immunisation: Tetanus

Immunisation: Polio

Immunisation: HIB

Immunisation: Meningitis B

Immunisation: MMR

Immunisation: Chicken Pox

Immunisations - Other (please state)

Has your child had Chicken Pox?

Has your child had Mumps?

Has your child had Measles?

Has your child had Rubella?

Special Dietary Requirements

Allergies or Preferences

Special Health Requirements or Medical Conditions

Special Needs or Disability

Regular Medication Requirements

Language(s) Spoken at Home

Main Religion in Family

Special Religious Requirements

Admission
EHAS Club Ltd is registered for 70 children between the ages of 4 and 11 years and is run in accordance to OFSTED rules and regulations.
EHASC does not discriminate against any child on the ground of sex, race, religion, colour or creed. Families, staff and volunteers are not excluded or discriminated.
Securing your childs place
Your child’s place will be reserved on receipt of a written acceptance and a non-refundable fee of £50 is received. A deposit payment will also be taken of a full week’s fee. This amount will be refunded when the child starts the club, subject to the terms and conditions. Only then will we guarantee the desired hours and days.
Fees
Fees are payable every calendar month. We accept payments via Vouchers and Direct Debit. Fees must reach us on or before the 1st of the month.
If fees are not paid after 3 working days we reserve the right to refuse admission. A supplementary fee of £5 will be charged for each late day.
In the event of the fees to the club being unpaid or outstanding, a child may, at the discretion of the club and in writing to the parent, be required to leave the club.
We would be grateful if all fees are paid on time to avoid embarrassing reminders.
The club reserves the right to increase fees at any time.
Notice of removal
Two full months’ notice in writing must be given for any child leaving or reducing sessions.
Sessions
We operate to a minimum of 1 session per week. Any additional sessions will depend on availability and are paid in advance, via cheque or cash on the day of session.
Sickness
If your child is showing signs of illness, they should not attend the club until better. It is unfair on them, the other children and the staff.
If your child becomes ill during the club day we will endeavour to contact you in the first instance and attempts made to arrange early collection. If your child becomes contagious with a disease they must remain at home until a doctor clears them to return.
The club manager reserves the right to refuse entry to any child for medical reasons.
Please let us know before 10.30am if your child will not be attending.
We are unable to administer medicine unless written consent from parents/carers with clear instructions laid out.
All prescribed medicines will be administered at our discretion and in conjunction with the consent form.
Allergies
It is a parent’s responsibility to ensure the club is briefed and kept up to date should your child’s needs change. Our meals are prepared and meet all dietary requirements. The Club cannot be held responsible for foods that may contain nuts.
Smoking
No smoking is allowed on the premises or the adjoining grounds at any time.
Forced closure
Full fees are payable to retain the place in the club.
In event of the club being unable to open due to circumstances beyond our control (localised power failure, flooding & snow etc.) fees will be charged for the first 3 days of that period then cease until we open. Discounts will be taken from the next invoice month.
The daily charge is worked out pro rata over 38 school weeks.
Personal belongings
The club or its staff will not be held responsible for any personal items lost or damaged on the premises. All property must be marked with the child’s name. All soiled items will be placed in a bag. We would appreciate it if the children did not bring toys from home with them to the club. We advise parents that jewellery, money and food are not brought in or onto the premises at any time.
Collection
No child is permitted to be collected from the club by any person not known to the staff, under the influence of drugs or alcohol or under 16 years of age.
If at any time another suitable person is required to collect your child, please phone and inform the club. We operate a ‘password system’ if there is a change from ‘normal’ collection.
The club hours are 7.15am to 6.30pm. All children must be collected by the closing time of their session 6.30pm, if a late pick up occurs, a fee will be charged of £15 per quarter hour.
Entry System: Please ring the doorbell and wait patiently for a member of staff to let you in. Please do not allow any persons to enter when you do. We will accept them independently.
Data protection
In line with the data protection act all records are kept filed away and out of reach. Parents can have access to their child’s records at any time. All staff sign a confidentiality agreement.
Under the guideline of the principles as set out in the children’s act of 1995, section 22, it is our duty as carers to respond appropriately to any indication of maltreatment of any child under our care.

I have read the terms and conditions (please complete and submit)

Parent Signature (agreement to terms and conditions)

Child’s Name (confirmation)

Date (confirmation)

Date

The Key Centre Elvetham Heath Fleet Hampshire GU51 1HA 07551 821793 elvethamclub@naturallearningchildcare.co.uk

Registration Form

Child and Parent Details

Session Selection and Start Confirmation

Parent and Emergency Contact Details

Medical and Professional Care Contacts

Immunisations and Childhood Illnesses

Health, Diet, Language, Religion, and Collection Security

Terms and Signature Confirmation