Booking Form for Malearn Summer 2025 Holiday Club at Thomas Arnold Primary School

Parents Declaration: I confirm that my child is eligible for a free space.*

My child is eligible for benefits related free school meals.

If your child is not eligible for benefit-related free school meal. Other options include:

booking a place for a child considered to be vulnerable
booking a discounted paid places (£20 per day)

Click the booking link for any of the above two options:

https://form.jotform.com/Malearn/AdditionalSummer25ThomasArnoldPrima

Please select the days you require for your child to attend:*

Name of Child:*

First NameLast Name

Childs Address:*

Street Address

Street Address Line 2

CityState / Province

Post Code

Child Date Of Birth - DD/MM/YYYY:*

Gender*

FemaleMale

Primary School*

School Year*

Parent / Guardian 1 Name:*

First NameLast Name

Relation to the child:*

Parent / Guardian 1 Home Number:*

Area CodePhone Number

Parent / Guardian 1 Mobile Number:*

Area CodePhone Number

Parent / Guardian 1 Email:*

example@example.com

Parent / Guardian 2 Name:

Relation to the child:

Parent / Guardian 2 Home Number:

Parent / Guardian 2 Mobile:

Parent / Guardian 2 Email:

Emergency Contact 1:*

Full NameRelationship To Child

Emergency Contact Number 1:*

Area CodePhone Number

Tell if your child has any Food Allergies / Dietary needs / Any other allergies:*

Special needs / Learning Difficulties/ Health Requirements/ any ongoing medical health condition. If your child has SEN, do they require 1 to 1 and what support can we provide?*

Is there any safeguarding and child protection information that we should be aware of to ensure safety of your child? (Optional):

Any Other Comments, Please Specify (Optional):

Please tick the box which applies

1. Name and Relationship:*

Name of adult collecting the childRelationship 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

Password for Collection

I give consent for Malearn to provide emergency medical advice/ treatment to my child:*

YesNo

I give consent for Malearn to administer first aid to my child:*

YesNo

I give consent for Malearn to take and use photograph of my child:*

YesNo

I give consent for Malearn to take and use video of my child:*

YesNo

I know to inform Malearn of my child's allergies and food intolerance:*

YesNo

Other comments and additional information

Terms and Conditions:

1. Parent needs to complete an application form for each child to attend our Summer Holiday Activity and Food Programme.

2. The Programme will be running Monday to Thursday 28th July 2025 to 14th August 2025 from 10am to 2pm.

3. Places are free for children receiving benefit related free school meals and / or consider to be vulnerable children. You will receive an automatic email confirmation of your place. Our Manager will telephone to confirm places for children with SEND and to put all requires support in place.

4. There are a few places for vulnerable children not receiving benefit related free school but will be allocated subject to availability. You will receive an Email confirmation from a staff, please check your inbox and spam. You can book using this link https://form.jotform.com/Malearn/AdditionalSummer25ThomasArnoldPrima

5. Discounted paid places are available at £20 per day. You will receive an Email confirmation and an invoice from a staff, please check your inbox and spam.You can book using this link.

https://form.jotform.com/Malearn/AdditionalSummer25ThomasArnoldPrima

6. Parent needs to drop off and pick up their children from the programme each day. You will be asked to sign your child in and out each day when being handover by a staff.

7. Parent must notify us in advance if their child is unable to attend so that this space can be offered to another child.

8. Parent needs to notify us in if their child is showing signs of contagious illnesses such as Strep A, COVID-19 or any other illnesses. Your child will be required to stay home until they are well.

9. Parent must notify us if your child is suffers from any other infectious or contagious disease. Your child may need to stay at home.

10. We will offer children a free healthy hot lunch and snacks each day.

11. Children will be involved in a range of activities, such as arts and crafts, painting, sports activity and cooking activity.

12. We will not be liable for loss or damage to any clothing or toys that children may bring to the club.

13. Parent needs to provide the names of people (including yourself) who will be authorised to collect your child.

14. Parent has the responsibility to notify us if any of the details changed after completing this registration form.

15. Malearn Limited reserves the right to amend the Terms and Conditions, as deemed necessary.

16. Parent agrees for information provided in this form to be shared with London Borough of Barking and Dagenham and Department of Education.

17. Parent agrees to recieve an automated confirmation email when the application form has been completed.

I have read the terms and condition for the Holiday Activity and Food Programme and I agree to abide by the terms and conditions of this agreement.

I have read and agree to the Terms and Conditions*

YesNo

Name of the person filling the form*

First NameLast Name

Signature:*

E.g. M. SMITH

Date:*

DD//MM/YYYY

Booking Form

Summer Holiday Activities and Food Programme Monday to Thursday, 28/07/2025 to 14/08/2025 from 10am to 2pm

If you need help filling the form

Does your child need medication with regards to a medical condition or food allergy? If so, please complete our medication form if any medication would need to be administered whilst with us.

Ethnicity

Collection Consent Form

I understand that I must inform the staff if the collection arrangements change.

Record of Parent Permission & Consent

Emergency medical advice / treatment

First Aid

Photographs

Videos

Allergy / food intolerance / consistent dislike