Registration Application Form 2018-19

1

School* This field is required.Please indicate which primary school your child will attend during term-time for the 2019-20 school year.

2

Class* This field is required.Please indicate which class your child will be in for the 2019-20 school year.

3

HYNDLAND ONLY - Will your child require breakfast club?

4

First Name* This field is required.

5

Middle Name(s)

6

Last Name* This field is required.

7

Preferred NamePlease let us know if your child prefers to be known by a name other than his or her first name.

8

Current Age* This field is required.

9

Date of Birth* This field is required.

10

Gender

11

Main Address* This field is required.

12

Main Post Code* This field is required.

13

SiblingsPlease type in the names and ages of any siblings.

14

Section 1 - Notes

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Name* This field is required.

16

Relationship to Child* This field is required.

17

Email Address* This field is required.Please type in your email address twice to ensure it is correct.

Confirm Email

18

Home No.* This field is required.

19

Mobile No.* This field is required.

20

Work No.* This field is required.Please type 'N/A' if you are studying or not currently working.

21

Alternative No.

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Home Address* This field is required.

23

Home Post Code* This field is required.

24

Work Name* This field is required.Please type 'N/A' if you are studying or not currently working.

25

Work Address* This field is required.Please type 'N/A' if you are studying or not currently working.

26

Work Post Code* This field is required.Please type 'N/A' if you are studying or not currently working.

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Name

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Relationship to Child

29

Email AddressPlease type in your email address twice to ensure it is correct.

Confirm Email

30

Home No.

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Mobile No.

32

Work No.

33

Alternative No.

34

Home Address

35

Home Post Code

36

Work Name

37

Work Address

38

Work Post Code

39

Section 2 - Notes

40

In the event of an emergency, or if we need to get in touch urgently, we will always contact parents and carers first.

Please provide details in the next section, of people we should contact if we cannot get in touch with parents and carers.

41

Name

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Relationship to Child

43

Mobile No.

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Work No.

45

Alternative No.

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Home Address

47

Home Post Code

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Name

49

Relationship to Child

50

Mobile No.

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Work No.

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Alternative No.

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Home Address

54

Home Post Code

55

Name

56

Relationship to Child

57

Mobile No.

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Work No.

59

Alternative No.

60

Home Address

61

Home Post Code

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Section 3 - Notes

63

In the next section, please list people, other than parents and carers, who are authorised to collect your child from our settings.

You may leave this section blank if the details are the same as the information provided in the 'Emergency Contacts' section.

64

Name

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Relationship to Child

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Mobile No.

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Work No.

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Alternative No.

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Home Address

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Home Post Code

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Name

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Relationship to Child

73

Mobile No.

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Work No.

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Alternative No.

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Home Address

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Home Post Code

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Name

79

Relationship to Child

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Mobile No.

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Work No.

82

Alternative No.

83

Home Address

84

Home Post Code

85

Section 4 - Notes

86

If this is a re-registration , please tick the days your child currently attends.After school service only.

Monday

Tuesday

Wednesday

Thursday

Friday

87

If you wish to amend the days from August*, please tell us all days you would like your child to attend.*Please note, availability of extra days will depend on the waiting list. The middle of the week tends to have the longest waiting list.

Monday

Tuesday

Wednesday

Thursday

Friday

88

If your child is new to the after school club, please tick the days you would like your child to attend.Your child's name will be added to the waiting list, and we will be in touch when places become available. Please note, we do not currently have a waiting list at our Thornwood service.

Monday

Tuesday

Wednesday

Thursday

Friday

89

Section 5 - Notes

90

Doctor's Name

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Doctor's Surgery* This field is required.

92

Doctor's Number* This field is required.

93

Doctor's Address

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Doctor's Post Code

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Does your child have any known medical issues?* This field is required.

No

Yes

96

If you answered "Yes" to "Does your child have any known medical issues?", please provide full details in this box and note you may need to fill out and sign additional medical forms.

97

Is your child on any regular medication?* This field is required.

No

Yes

98

If you answered "Yes" to "Is your child on any regular medication?", please provide full details in this box and note you may need to fill out and sign additional medical forms.

99

Does your child require any help administering regular medication?* This field is required.

No

Yes

100

If you answered "Yes" to "Does your child require any help administering regular medication?", please provide full details in this box and note you may need to fill out and sign additional medical forms.

101

Does your child have any special dietary requirements?* This field is required.

No

Yes

102

If you answered "Yes" to "Does your child have any special dietary requirements?", please provide full details in this box and note you may need to fill out and sign additional medical forms.

103

Does your child have any disabilities?* This field is required.

No

Yes

104

If you answered 'Yes' to "Does your child have any disabilities?", please provide full details in this box.

105

Does your child have any learning difficulties?* This field is required.

No

Yes

106

If you answered 'Yes' to "Does your child have any learning difficulties?", please provide full details in this box.

107

Does your child have any additional needs?* This field is required.

No

Yes

108

If you answered 'Yes' to "Does your child have any additional needs?", please provide full details in this box.

109

Section 6 - Notes

110

Short Trips* This field is required.Are you happy for your child to participate in short trips off the premises? (e.g. to the library)?

No

Yes

111

Swimming* This field is required. Are you happy for your child to go on a swimming trip? (Please note we only take confident swimmers aged eight and over and prior notice of any swimming trips will be provided.)

No

Yes

112

Face Paint* This field is required.Are you happy for your child to have his or her face painted?

No

Yes

113

Henna* This field is required.Are you happy for your child to get henna tattoos?

No

Yes

114

Taxis* This field is required.Are you happy for your child to travel in a taxi?

No

Yes

115

Basic First Aid* This field is required.Are you happy for your child to receive basic first aid by our qualified members of staff?

No

Yes

116

Emergency First Aid* This field is required.Are you happy for our senior members of staff to sign any written form of consent required by hospital authorities if the delay in getting your signature is considered by them to endanger your child's health and safety?

No

Yes

117

Photos (1)* This field is required.Are you happy for your child to be photographed and for the photos to only be shown within the setting?

No

Yes

118

Photos (2)* This field is required.Are you happy for photos of your child to be used on our club's website and printed media (e.g. newsletters and guides)?

No

Yes

119

Videos* This field is required.Are you happy for your child to be filmed and for the films to only be shown within the setting?

No

Yes

120

Social Media* This field is required.Are you happy for photos of your child to be used on the club's social media accounts? (Please note we will never publish your child's name or any personal details with any photo.)

No

Yes

121

Sun Screen* This field is required.Are you happy for your child to be offered high-quality, high-factor sun screen on sunny days? (Please note children will apply sun screen themselves and, while we will encourage them to wear it, we will never force them to if they say they do not want it.)

No

Yes

122

PG Movies* This field is required.Are you happy for your child to watch PG movies?

No

Yes

123

Medical Information* This field is required.Are you happy for your child's details to be displayed on our allergy, dietary and medical lists for our staff to see?

No

Yes

124

Section 7 - Notes

125

What is your child's preferred language?

126

What is your child's ethnicity?

127

What is your child's religion?

128

How did you hear about our club?* This field is required.

129

Section 8 - Notes

130

If accepted, this Registration Application forms the basis of your contract with the club. Please read our Fees, Terms and Conditions (This may open on a separate page, or download as a PDF). All information on this form will remain confidential in accordance with our confidentiality policy. This information will be reviewed after six months in line with Care Inspectorate regulations.

Please note: Fees, Terms and Conditions run from July 2019 - June 2020.

131

* This field is required.

132

* This field is required.I have read, accepted and submitted Hyndland After School Club's {Privacy Policy}. You will have to complete this Privacy Policy before submitting.

133

* This field is required.As I have stated I may use the Breakfas Club service at Hyndland After School Club, I have read and accepted Hyndland After School Club's Breakfast Club policy.

134

Please state whether you give permisson for your child to leave Breakfast Club at the following time and accept responsibility for them until they are in school at 9am.

I give permission for my Primary 2 child to leave Breakfast Club early at 8:55am.

I do not give permission for my child to leave Breakfast Club early.

135

Please state whether you give permisson for your child to leave Breakfast Club at the following time and accept responsibility for them until they are in school at 9am.

I give permission for my Primary 3 child to leave Breakfast Club early at 8:50am.

I do not give permission for my child to leave Breakfast Club early.

136

Please state whether you give permisson for your child to leave Breakfast Club at the following time and accept responsibility for them until they are in school at 9am.

I give permission for my Primary 4, 5, 6 or 7 child to leave Breakfast Club early at 8:45am.

I do not give permission for my child to leave Breakfast Club early.

137

Your Name:* This field is required.

138

Signature* This field is required.

Clear

139

Date* This field is required.

Date

140

General Notes

141

You will know almost immediately if your form has submitted successfully. You will receive an emailed copy of your form.

Please note the form will not submit unless:

You have completed all the fields with an *
You have typed in your email address twice
You have read and signed the privacy form
You have read, accepted and ticked the box for the Fees, Terms and Conditions