Holiday club registration form

    About your child

    Gender
    Date of Birth
    (For an adult we dont recognise whom you ask to pick up your child)

    Parent / Carer Details

    First Parent / Carer

    Lives at the child's home address?
    Home address and postcode

    Second Parent / Carer

    Lives at the child's home address?
    Home address and postcode
    Who has legal Parental responsibility? Please see the official definition of parental responsibility to ensure you have answered this correctly.

    Other Significant Contacts

    Use this section to tell us about other adults who may act on your behalf if needed.

    First Adult

    Can they collect your child? Can they take parental decisions in an emergency?

    Second Adult

    Can they collect your child? Can they take parental decisions in an emergency?

    Third Adult

    Can they collect your child? Can they take parental decisions in an emergency?
    If you wish to add any more adults, please do so using the additional information section at the end of the form.

    Doctor

    Address Telephone

    Health Questions

    Can we give your child first aid / emergency medical treatment?

    You have told us that we may not administer first aid in any circumstances. We will need to discuss your wishes further before we finalise your registration, to enusre we are able to care for your child properly.

    Does your child have any non food allergies?

    Does your child have any illness or condition we must manage in order to care for them properly?

    Is your child on any long term medication?

    Does your child have any special needs?


    Please provide us a description of your child's situation, including symptoms, severity and treatment as appropriate. If you feel this space is not suitable or appropriate to the situation, please let us know below and we will arrange an appropriate discussion.

    Diet

    Does your child have any food allergies?

    Is your child a vegetarian?

    Does your child have any special dietary requirements?

    Please provide more information about any questions you have answered yes to, and add any other dietary notes you wish us to take account of.

    Even if you do not expect your child to eat whilst at Teatimers, we will always be preparing food whilst they are in the building. It is important we know anything relevant about food related matters and allergies.

    Permissions

    Can we take photos of your child for internal use?
    Photos are a great record when your child has done something special.
    Can we display these photos around the site?
    Generally this means putting up photos around Teatimers where other families and prospective parents will see them. If we wanted to use them for a wider purpose, we would ask for your specific permission.
    Can we use these photos on our facebook page?
    (our facebook page is restricted to Teatimers families only)
    Can we take your child on local trips on foot?
    This means things like a walk to a nearby park on a nice day, a nature walk or a trip to post a letter. It applies mostly to Holiday club.
    Are there any specific named adults who may not have access to your children?
    (If so, we will contact you separately to work out appropriate arrangements

    Any further comments regarding permissions?

    Languages Spoken

    Ethnicity

    For local authority audit purposes, please choose the appropriate ethnicity code for your child.

    Additional information

    Please tell us anything relevant about your child that will help us to care for them. For example - things that will upset them and calm them down - favourite activities - Accident prone / tendency to run off

    Declaration


    Signed
    Signed Date
    Preschool spaces available