SYDENHAM AFTER SCHOOL CLUB Registration Form Child's Details Name * Date of Birth * Day/Month/Year Current Year Group * Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Year 13 Add Remove Parent/Carer Details Name * Home Address/Postcode * Home Phone * Relationship to Child * Mobile * Email Address * Add Remove Alternative Emergency Contact Details Please provide details of at least one other person we can phone if we are not able to contact you Name * Home Address * Home Phone * Relationship to Child * Mobile * Email Address * Add Remove Finance Weekly Total (£) Please tick as appropriate: * Working Tax Credit Student Finance Self-Funding Other (Specify)Other (Specify) 2 weeks’ deposit paid? Yes No About Your Child Please detail any additional/special needs: * Please detail any medical needs including details of any medication: * Please detail any allergies: * Please detail any dietary requirements: * Is there anything else that you think we should be aware of (religious requirements, behaviour, family situation, communication)? Terms & Conditions Terms and Conditions ◘ I consent to my child attending Sydenham After School Club. I understand that the club has policies and procedures and there are expectations and obligations relating to the conduct of myself and my child and I agree to abide by them. ◘ I will inform Sydenham After School Club if my child will not be attending the club on a day that he/she is booked into the club. ◘ I will pay promptly for sessions even when my child does not attend unless other arrangements have been made with the manager. Please note- You will still be charged for any session/s that your child/ren is/are absent from the club. It is your responsibility to arrange catch-up sessions with the manager to cover the missed day. ◘ I understand that persistent late or non-payment of fees may jeopardise my child’s place. ◘ I agree to pay fees on a weekly basis (unless alternative arrangements have been made with the manager). ◘ I give permission for a member of staff to administer appropriate first aid if required. ◘ I give permission for a member of staff to seek any necessary emergency medical advice or treatment if my child is involved in a serious accident. ◘ I understand that the information given on this registration form is confidential. However, there may be times, for example in the case of child protection concerns, when details may be passed to other agencies in line with the child protection policy. ◘ Where the club has endorsed my claim for Childcare Working Tax Credit I understand that I am legally obliged to notify the Inland Revenue if I cease to use the service during the period of my claim. ◘ I confirm that the information given on this form is correct and agree to notify the club of any changes in detail. ◘ I have read and, in signing this form, accept the above conditions for my child attending Sydenham After School Club. ◘ In the event of illness or accident requiring hospital treatment, I hereby authorise the scheme’s play care workers to sign any written forms of consent required by hospital authorities if the delay in obtaining my own signature was considered inadvisable by the doctor or surgeon concerned. Consent * I have read, understand and agree to all the terms and conditions as set forth above. Sign off Name Signature/initials Date Submit
