Breakfast Club / After-School Club/ Holiday Club

CHEEKY MONKEYS CHILDCARE CENTRE:

BREAKFAST CLUB / AFTER-SCHOOL CLUB/ HOLIDAY CLUB

Company Number 9939678

Information Form and Contract

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Full Name of Child......

Date of Birth of Child...... Nationality………………………

Home Telephone Number......

Home Address......

...... Postcode...………......

Religion or belief of family...... Ethnic Origin………......

Child’s Gender Male [ ] Female [ ]

Parent/Carer’s email address ………………………………………………………………

Parent/GuardianDetails

Parent/Guardian‘s Name...... D.O.B......

Any previous names used…………………………………………………………………..

Parent’s work address......

Parent’s work number ...... Mobile....………......

Does this parent/guardian live with the child? Yes [ ] No [ ]

Does this parent/guardian have parental responsibility for the child?*Yes [ ] No [ ]

Second Parent/Guardian Details

Parent/Guardian‘s Name...... D.O.B......

Any previous names used………………………………………………………………….

Parent’s work address......

Parent’s work number ...... Mobile...... ……......

Does this parent/guardian live with the child? Yes [ ] No [ ]

Does this parent/guardian have parental responsibility for the child?* Yes [ ] No [ ]

*(According to the Children’s Act 1989 Parental Responsibility is given to both the child’s father and mother where they are married to each other at, or after, the child’s conception. In the case of unmarried parents, the mother has parental responsibility and thefather does not have parental responsibility for his child unless he acquires it)

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Names, ages and school of siblings:

1. Name…………………………...…DOB.……….....School......

2. Name……………………………...DOB...... School......

3. Name……………………………...DOB...... School......

What School does your child attend? ……………………………………………………

(BREAKFAST CLUB AND AFTER-SCHOOL CLUB ONLY)

School address ….………………………………………………………………………......

School telephone number ………………………………………………………………....

Year and Class name/number ……………………………………………………………..

What time does your child start school? ………………………………………………..

What time does your child finish school? ………………………………………………

Breakfast Club / After-School Club / Holiday Club Hours - Please tick where appropriate:
Monday Tuesday Wednesday Thursday Friday
a.m p.m a.m p.m a.m p.m a.m p.m a.m p.m
[ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Persons who can collect your child and whom we can call in an emergency – we will always call parents first unless informed otherwise.
Please note that we can only release your child to persons over the age of 16yrs. In the event of a letter from the parent/guardian we will permit a child of 14+ to collect your child in cases of emergency.
Name / Name:
Address: / Address:
Tel: / Tel:
Relationship to child: / Relationship to child:
Password: / Password:

Child’s Doctor’s Name...... Tel......

Doctor’s Address......

Any dietary requirements?…………………………………………………………………

Any allergies/health problems?…………………………………………………………...

If your child has an allergy we would put a care plan in place for them with the assistance of our Community Nurse.

Does your child have any additional needs and/or disabilities? …………………......

………………………………………………………………………………………………….

If yes, please list any outside agencies involved in the care of your child………………

………………………………………………………………………………………………….

…………………………………………………………………………………………………..

If yes, what support will your child require in our setting? …………………………………

………………………………………………………………………………………………….

Does your child have any individual needs? ………………………………………………

…………………………………………………………………………………………………..

Has your child ever had a play plan or behavior plan? Yes [ ] No [ ]

Any other information we need to know concerning your child ………………………..

………………………………………………………………………………………………….

Has your child/ren ever been referred to Children’s Advice and Support Service, (CASS)?
Yes [ ] No [ ]
If yes, for what reason…………………………………………………………………...
Name and telephone number of Social Worker allocated to your family:
Name…………………………………………Telephone.……………………………...
I have been made aware and understand that any carer who suspects a child in his or her care may have been abused or neglected has a duty by law to inform Children’s Advice and Support Service, (CASS). I understand that I may not be informed prior to this.
WE ARE A NO SMACKING CHILDCARE CENTRE AND PARENTS/CARERS MAY BE REFERRED TO MULT-AGENCY SAFEGUARDING HUB, (CASS) IF THEY ARE SEEN SMACKING THEIR CHILD/REN.
I understand that it is a requirement of the Birmingham Safeguarding Children Board that the setting record all verbal and written correspondence between the parent/carer and the setting. I understand that these forms will then be passed on to my child’s school or new childcare setting when they leave.
Maggie Lewis is the Designated Senior Lead, (DSL)

CONSENT

Please tick and sign below

Consent for: / Yes / No
HEALTH
For a member of staff to accompany your child to hospital in an emergency and treatment carried out if need be. We would always attempt to contact you first(refer to the H&S Policy).
The use of plasters on my child.
To give my child Piriton if they suffer from hay fever or a sting or such like.
To administer Calpol/Ibuprofen to my child in the event of illness or temperature.
To apply Tesco’s own brand sun cream in the absence of the child’s own (refer to the Sun Cream Policy).
To travel in the cars of members of staff – all staff are fully insured and hold full drivers licenses
I give my permission for my child to go on any spontaneous outings which includes traveling in the Centre’s minibus
I agree to have my child’s observations to be stored on a secure website (Tapesty)
PHOTOGRAPHS
To allow staff to take appropriate photographs of my child to be displayed around the Centre and entered into theirs and their friends programs.
To allow staff to take appropriate photographs of my child to be used in suitable literature or publications such as prospectus’s or newsletters used for the Childcare Centre.
To allow staff to take appropriate photographs of my child to be used on the Childcare Centre’s website, social media such as facebook, twitter and on the internet. Photos will be available for parents to view their child’s photos from the above sites.

Contracted Hours and Fees

Breakfast Club – 7.30am – 8.45am = £5.00 per day

This includes a choice of cereal and toast with milk or water and dropping your child off at school in the morning.

After-School Club – 3:00pm – 7:00pm = £15.00 per day OR £70.00 per week

This includes collection from school and a light tea of sandwiches/ soup/ beans on toast for Tea Time. A selection of fresh fruit and water is available at all times.

Holiday Club – 8.00am – 6.00pm = £22.00 per day (plus the cost of any trips) OR £100.00 per week (plus the cost of any trips)

This includes a choice of cereal and toast with milk or water for breakfast. A packed lunch will be required from home for Lunch Time with a minimum of 2 drinks. A selection of fresh fruit and water is available at all times.

TERMS AND CONDITIONS

A refundable deposit of £50.00 is required to secure your child’s place when confirmed. This will be deducted from the balance of your last invoice providing there is no outstanding balance on your account and the relevant four weeks notice was given. However, if the place is not taken, the £50.00 will not be refunded. If you are asked to leave due to non-payment of fees, or any other viable reason, the deposit may not be refunded.

Parents and Carers must be prompt in dropping their child/ren off and collecting them at the times agreed. For the Holiday Club, parents and carers must be prompt at collecting their child at 6.00pm. As we have planned activities, we will be leaving the Centre at 10.00am every morning and returning at 5.00pm on trip days. We cannot wait for latecomers so if your child is late during trip days, your money will not be refunded due to lateness if you have booked your child in.

There will be an extra cost for any trips and excursions. This is non-refundable in the event of you cancelling your child’s place unless we fill the place. For the Holiday Club, one weeks notice is required to cancel any days booked. If your child is absent due to sickness or cancellation within less than 5 working days then full payment for the day and the trip will be required.

If your child is sick you will be called to collect your child from the Centre. This may be from the location of the trip if out on an excursion. If parents/carers and their emergency contacts are unable to be contacted due to non-answering of phones or incorrect numbers then the Centre will call Children’s Information and Advice Service, (CIAS) after 1 hour of trying. This is at times of lateness and/or sickness.

Children must not attend the Centre suffering from any infectious or contagious illnesses and must inform staff if suffering from any infectious or contagious illnesses.

You must send your child with any inhalers or regular medication which your child may need every day. Children will be responsible in carrying their own inhaler and will self- administer it with adult supervision. Failing to do this may result in them being sent home.

For the Holiday Club, payment for excursions must be paid when booking into the club due to paying venues in advance. This is non refundable unless we fill the place.

Parents/Carers arriving to collect their children after the contracted hours will be charged £10.00 for every 15 minutes or part of, per child. Continual lateness is not permitted – this may result in you losing your child’s place with no reimbursement of fees paid.

All weekly fees can be paid in advance or on the first day of attendance in that week via bank transfer or cheque. We do not accept cash on the premises. If fees are paid late, there will be a late fee charge of 10% of the childcare fees.

Parents/Carers must reimburse the Centre for any bank charges incurred in respect of any represented cheques.

The centre is closed on Bank Holidays and during the Christmas period for one week. Payment will be required for Bank Holidays.

Do not send your child with any money, mobile phones or i-pods or such like as we will not be responsible for any lost items.

For the Holiday Club, parents/carers must send their child with a healthy packed lunch with at least 2 drinks, adequate clothing appropriate for the activity and sun cream when required.

Parents and Carers must send their child/ren in adequate clothing appropriate for the weather, including sun cream when required.

You must encourage your child to abide by the rules set in the Centre.

The Centre is fitted with indoor and outdoor CCTV, should this need to be seen for any reason, we are not permitted to ask parents’ permission beforehand.

We will be abiding by the policies and procedures of the Childcare Centre.

We will have carried out risk assessments of some of our trips and excursions but most of them we will risk assess as we go.

The children will be transported in a Minibus and a fully insured car driven by a staff member. Car seats will be used for the younger children and booster seats are available.

I have been truthful in completing this form. I understand that there may be circumstances where the setting may share information with other professionals or outside agencies without my consent.

I understand that my child’s birth certificate will be copied and retained on my child’s file as proof of parentage/parental responsibility and that it will remain on my child’s file until it is destroyed in line with the Childcare Centre’s Data Protection Policy.

I understand that the proof of my address will be seen by two members of staff and the document will be copied and returned to me immediately.

Completed by (print name)………………………………………. Parent/Guardian

Signed by the above...... Date......

Signed …………………………………………………. Manager/Proprietor

Print name …………………………………………….

(on behalf of Cheeky Monkeys Childcare Centre Breakfast Club / After –School Club / Holiday Club)

Management to complete

Copy of policies and procedures given [ ] Date………………………..

Sign and copy contract and give to parent/carer [ ] Date…………………

Acceptance letter sent [ ] Date……………………………..

Childcare Centre’s Rules explained [ ] Date……………………………

Deposit paid [ ] Date …………………………………….

Permissions Form updated ( ) Date …………………………

Proof of address seen and copied [ ] Date………………………………..

Document seen…………………………………. Date of Document………………………………

MUST BE RECENT DOCUMENT

Seen by Management (signed)………..………………………..

Witness (signed) ………………………………………

Child’s Birth Certificate seen [ ] Date………………………………..

ANDCOPY TAKEN AND RETAINED ON FILE ( )

Cheeky Monkeys Outdoor Contract

Name of my child...... Date of birth......

I...... parent/guardian fully commit to the Cheeky Monkeys Childcare Centre ethos and commitment to the outdoor environment as set in the Cheeky Monkeys outdoor contract.

I understand that my child will have the free choice to go outdoors in the garden with staff when they choose.

I also understand that if my child is not well enough to go outdoors, then I will not send him/her to the Centre.

Parent/Carer Signature...... Date......

Cheeky Monkeys Consent For Going Outdoors

Name of my child...... Date of birth ......

Cheeky Monkey Childcare Centre staff and children go out on regular walks around the community to look for nature, collecting leaves or a wander to the park. As these walks are spontaneous we are unable to let you know when we are going beforehand and therefore need your written consent.

By signing below, you are giving your permission for these walks and may necessarily be informed about it on the day. We would always gain prior written permission if we were taking any kind of transport.

I...... parent/guardian agree to allow Cheeky Monkeys Childcare Centre’s staff to take my child out for a walk when they choose. I understand that there will be a suitable staff to child ratio and that staff will risk assess at all times.

Parent/Carer Signature...... Date......

Cheeky Monkeys PG DVD Consent Form

Name of my child...... Date of birth ......

Cheeky Monkey Childcare Centre have a range of DVDs rated U and PG. We would like to ask your permission if you are happy with your child to watch a PG rated movie. A staff member will be present when your child is watching a movie

I...... parent/guardian give my permission for my

child………………………………. To watch a PG rated movie.

Parent/Carer Signature...... Date......