BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Child’s Details
Forename:______Surname:______
Gender:______Date of Birth:______
School Attending:______
A registration form must be completed for each child before a booking can be accepted.
BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Parent(s)/Carer(s) details with whom child lives with
A registration form must be completed for each child before a booking can be accepted.
BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Parent/Carer 1:
Name:______
Relationship with Child:______
Parental Responsibility?:Yes / No
Emergency Daytime Contact Number:______
Parent/Carer 2:
Name:______
Relationship with Child:______
Parental Responsibility?:Yes / No
Emergency Daytime Contact Number:______
A registration form must be completed for each child before a booking can be accepted.
BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Address:______
______
Postcode:______Contact Number:______
Email:______
Additional Emergency Contact Details (i.e. relative or friend)
A registration form must be completed for each child before a booking can be accepted.
BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Emergency contact 1:
Name:______
Relationship with Child:______
Contact Number:______
Emergency contact 2:
Name:______
Relationship with Child:______
Contact Number:______
A registration form must be completed for each child before a booking can be accepted.
BEANE VALLEY HOLIDAY CLUB
Venue: Watton at Stone Primary and Nursery School, Rectory Lane, Watton at Stone, SG14 3SG
Telephone: 01920-831053 or 07531 749834 Email: Web:
REGISTRATION FORM
Doctors Details
Doctors Name:______
Surgery Adress:______
______
Postcode:______Contact Number:______
Medical Information
Health & Medical Requirements (any health conditions, medical requirements, disabilities, behaviours or impairments):
Allergies:
Any other information you think is relevant:
Consent
I give my full consent for the above named child to receive first aid treatment in the event of an accident by a trained first aider.
Signed:______Date:______
Whilst every attempt will be made to contact you or your emergency contact in the event of a Medical Emergency, if we are unsuccessful your permission is required to take any appropriate Emergency Medical Treatment or advice, including taking the above named child to hospital to receive appropriate treatment.
Signed:______Date:______
I consent / do not consent (delete as appropriate) to the above named child being photographed/videoed during Beane Valley Holiday Club for the purpose of general records or for local advertisement.
Signed:______Date:______
I give my full consent for a staff member to apply sun cream to the above named child on hot summer days.
Signed:______Date:______
Agreement
As the parent/carer of the above named child, I confirm that the information given is correct to the best of my knowledge. I understand that sessions booked and not attended for whatever reason will still be charged as absences are non-refundable.
Full Name:______Signed:______Date:______
Please Circle
Has the provision of Beane Valley Holiday Club enabled a parent/carer to continue working? YES / NO
Has the provision of Beane Valley Holiday Club enabled a parent/carer to take up employment? YES / NO
A registration form must be completed for each child before a booking can be accepted.