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Registration Form 2017

‘Get Active’ After School Childcare

Before your child can be a part of the ‘Get Active’ after school club, we need to record basic information about your child that will be kept confidentially to enable us to safeguard your child’s welfare, contact you in an emergency, evaluate the attendance and report the success of the activity/project to our funders. The information will not be passed to a third party unless we consider your child to be in danger of harm. Children will only be accepted to attend ‘Get Active’ once this form has been completed and returned by the parent/carer/guardian.

Fields marked with a * must be filled in.

PARENT CARER/1

PARENT CARER/2 (if applicable)

Please indicate which parent/carer your child normally lives with:

Please indicate which parent/carer has parental responsibility:



HEALTH AND DIETARY INFORMATION ABOUT YOUR CHILD

1. Any allergies your child has (including medication your child is allergic to)?

2. Any medication/treatment your child requires that we should be made aware of?

3. Any reason your child is unable to take part in physical activities?

4. Any special dietary requirements?

5. Any care/support needs - including SEN and/or a disability?

DECLARATIONS

Please identify the person/people who will usually collect your child.

I give consent for my child to be collected at the end of 'Get Active' session by the following people (please list) and I will inform them of a safety password to provide to the Get Active staff upon arrival.

I give consent to any emergency treatment necessary during the course of the session should a surgical operation or medical treatment be deemed necessary for the child’s health.

I agree that photos/videos may be taken during the activities to publicise 'Get Active', show funders, use on display boards and the 'Get Active' website. (These photos will be taken digitally and stored on a computer) Confidentiality of children’s details will be maintained.



ATTENDANCE
I would like my child to commence at 'Get Active' on:

(Parents/carers should be aware that ad hoc sessions must be booked in advance to ensure 'Get Active' have the capacity to accommodate your child/ren).

(Please also include an estimated collection time for each day)






Please note below the school your child attends:-



ETHNICITY


EMERGENCY CONTACT DETAILS
Your emergency contact must be someone else who we can contact in a situation where we are unable to reach you and is a responsible person of age.


AUTHORISATION

TERMS & CONDITIONS




 

Contact the High Street Centre for more information.

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