Malearn After School & Holiday Club@ Eldon Primary School

Which Club are you interested in?*

Eldon After School Club - Fee £12 per day per childEldon Holiday Club - Fee £25 per day per child

Name of Child*

First NameLast Name

Date of Birth*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityTown

Post Code

School*

YearClass

Parental Information

Mother Details*

First NameLast Name

Mobile Number*

House Telephone Number*

Email

example@example.com

Does this parent have parental responsibilities?*

YesNo

Father Details*

First NameLast Name

Mobile Number*

House Telephone Number*

Email

example@example.com

Does this parent have parental responsibilities?*

YesNo

Who will be paying for the club fee? (E.g. school, council, social worker, etc)

Name:

What email would you like the invoice to be sent to?

Contact number

Two other emergency contacts (in the event that parents/ carers cannot be contacted)

Emergency Contact 1 Details*

First NameLast Name

Relationship to Child:*

Address:*

Telephone Number*

Email

example@example.com

Emergency Contact 2 Details*

First NameLast Name

Relationship to Child:*

Address:*

Telephone Number*

Email

example@example.com

If you change you address after the application has been sent off please NOTIFY US.

Date you would like your child to start attending the club:*

Please tick the days you require your child to attend the After school club:*

Dates you would like your child to attend the holiday club (Please write N/A if this does not apply):*

I understand that the offer of a vacancy is subject to availability and I abide by the rules and regulations of the club. At present the Club takes children from 3 years to 11 years.

Medical Information

24 hours is the complusory duration in which we cannot except children into our club if they have suffered from sickness, diarrhea, conjuctivitis or any other highly contagioous illness.
Does your child need medication with regard to the medical condition or food allergy? If so, please complete our medication form if any medication would need to be administered whilst at the club

Additional Needs (Please write N/A if it does not apply to your child)

Food Allergies:*

Dietary Needs: (Please give details)*

Any other Allergies:*

Special needs/ health requirements:*

Any ongoing medical health condition:*

Child Protection: (Registration/ Category)

Is an Interpreter or signer required? (Please give details)

Has your child any learning difficulties and/ or disabilities?*

YesNo

What special support will he/ she require in our club?

Professionals known to be involved with the family

Registered GP:

Name of GP:*

Address of GP

Street Address

Street Address Line 2

CityTown

Post Code

Telephone Number

Additional Information:

My child has been immunised against: (Please tick)*

Diptheria/ tetarus/ whooping coughMeasles, mumps/ rubella (MMR)PolioNo

Has your child had any other infectious diseases or medical conditions that you would like to discuss with the manager?*

Please feel free to give us any additional information that you feel would be helpful to have on our records (e.g. birthmark or permanent skin abrasions, individual needs or personal circumstances)*

Child Profile

What is your child's home language?*

What is your child's favourite food?*

Can your child manage their own personal care needs?*

What are your child's favourite play activities, interests and hobbies?*

Tell us about cultural events for us to include in our activities:*

Ethnicity (Please tick the appropriate descrition)

(This part of the registration is voluntary, however the date is useful for evaluation purposes and for us to know the background of our children, in order to embrace and celebrate the similarities and differences.)

Asian

Asian IndianAsian PakistaniAsian BanglaeshiAny other Asian background

Black

Black CarribbeanBlack AfricanAny other Black background

Mixed background

White and Black CarribbeanWhite and Black AfricanWhite and AsianAny other mixed background

ChineseAny other ethnic backgroundWhitePrefer not to say

Collection Consent Form:

I understand that I must complete a new collection consent form if any other arrangments below change. The person collecting the child must bring an ID for us to verify who they are if we are not familiar with them.

1. Name of adult collecting the child*

Relationship with the child*

Please select one of the below:*

The person is able to collect my child at any time without prior notification from myselfI will always inform staff on the day if this person is going to collect my child

2. Name of adult collecting the child*

Relationship with the child*

Physical description:

Please select one of the below:*

The person is able to collect my child at any time without prior notification from myselfI will always inform staff on the day if this person is going to collect my child

Record of Parent Permission & Consent

Emergency medical advice/ treatment: I understand that if my child has an accident or becomes ill at the club, he/she may need emergency medical advice/ treatment. The staff will try to telephone me immediately. However, they may not be able to contact me. If such situation arise, I give permission for my child to receive emergency medical advice or treatment from ambulance/ doctor/ hospital.*

YesNo

First aid: I give my consent for basic first aid to be carried out by a trained paediatric first aider, if necessary. This includes used of plaster and alcohol- free antiseptic wipes if necessary.*

YesNo

Photographs: I understand that staff will take photographs or video of my child for his/ her profile, observations and displays in the club. At times, we may use photograph or video of children for training purposes in the club. I give my permission for my child's photograph or video to be used solely for the purpose confirmed.

For children's profile & learning book*

YesNo

For setting displays*

YesNo

For training at the nursery*

YesNo

Outings: I understand that my child will go on regular short visits in the local community that will be in line with the club/s outing policy. There will be a risk assessment for each outing. I give my permission for my child to go on these short outings*

YesNo

Allergy/ food intolerance/ consistent dislike: I understand that I must inform you in writing if my child has an allergy/ food intolerance/ consistent dislike of what is on offer so an alternative can be prepared.*

YesNo

Other comment and additional information:

Sun Cream Consent:

I give the club's staff consent to apply the sun cream that I provided during hot weather. This cream has been used on my child before and does not trigger any allergy reaction. It should be used a specidied below.

Sun Cream*

Factor of the cream is:*

Please tick below if applicable:*

The sun cream is to be appied once a day before the first outdoor play sessionThe sun cream is applied before every outdoor play sessionOther

All parents please tick the statement that apply to you: Please note: during the summer months, we asks all parents and carers to provide sun hats and appropriate clothing for their child.*

I give permission for staff to apply the above sun cream to my child. I understand that, having signed this statement, should I not provide the sun cream named above, my child may have to remain indoors during hot weather.I will be responsible for the application of sun cream during hot weather and I give permission for my child to play outside without further sun cream application by the club's staff.

Other comments and additional information Use this section to tell us above any relevant information about your child E.g. any updated medical information that have not already been mentioned above.

Terms and Conditions

You will be required to pay the club fees at the rate agreed. You will be charged for sessions booked rather than for sessions used.
After school club is from 3.00pm - 6.00pm and the daily rate is £12.00.
Holiday Club short day is from 9.00am – 2.00pm and the daily rate is £25.00.
Holiday club operates during Easter, Summer and Christmas break.
After school club snacks will be free of charge and this will includes healthy food options.
Holidy school club snacks and hot lunches will be free of charge and this will includes healthy food options.
Late collection of children not agreed in advance will be deemed to be unauthorised and will be charged at a rate of £0.50 per 5 minutes.
The fees can be made on weekly or monthly basis. If fees are paid monthly they become due on the first day of the month, in advance. Weekly fees are paid on your child’s first session at the club. All payments should be made by bank transfer only.
Government support can be viewed on the following two weblinks:
https://www.gov.uk/tax-free-childcare

https://www.gov.uk/guidance/universal-credit-childcare-costs
Fees are required to be paid before the week or month commencing.
Due to administration costs please note that late fees will incur a cost of 50p per day.
If the number of sessions are reduced or cancelled a 2 weeks’ notice needs to be given or a payment in lieu.
Please let the Manager know as soon as possible if your child is unable to attend a book session. Parents will be charged for booked session(s) even if your child do not attend. This include absence due to illness and isolation. Booked days can be swap for another day in the same week at no extra cost. Please note that the fee will not be reduced.
You must notify the club in writing (or by telephone in an emergency) if your child suffers from any infectious or contagious disease. You will be required to exclude.
You will need to provide the names of up to four people (including yourself) who will be authorised to collect your child.
Please note that Malearn After School & Holiday Club@ Eldon Primary School (Malearn Limited) will not be liable for lost or damage to any clothing or toys that children may bring to the club.
Please note that non-payment or late payment will constitute a breach of this agreement Malearn After School & Holiday Club@ Eldon Primary School (Malearn Limited) reserve the right to take any necessary action to recover all fees due and costs incurred in taking such action.
Malearn After School & Holiday Club@ Eldon Primary School (Malearn Limited) has the right at any time by giving notice (in writing) to terminate or change the agreement with immediate effect, if you fail to pay fees within 7 days of the due date.
Malearn After School & Holiday Club@ Eldon Primary School (Malearn Limited) reserve the right to amend the Terms and Condition, as deemed necessary.
Having read and understood the club policies and procedures and signed the emergency consent form, I am happy for my child to attend Malearn After School & Holiday Club@ Eldon Primary School.

I have received a copy of the current club fee schedule and I agree to abide by the terms and conditions of this agreement.

Name of person filling the form:*

Signature of person filling the form:*

Date:*

Malearn After School & Holiday Club@ Eldon Primary School

Fee

Emergency contact: