Please circle
Home Address: / Postcode:
School: / Year Group: / Class Name:
Does this child have a sibling at the club? / Name of Sibling:
Name ofContact 1: / Mr / Mrs / Ms
please circle
Relationship to child: / Does this person have Parental Responsibility for the child? / Yes / No please circle
If no, does this person have Legal Responsibility for the child? / Yes / No please circle
Home Address:(if different to child’s address): / Postcode:
Home Tel: / Mobile Tel:
Email: / Work Tel:
Work Name & Address:
Name of Contact 2: / Mr / Mrs / Ms
please circle
Relationship to child: / Does this person have Parental Responsibility for the child? / Yes / No please circle
If no, does this person have Legal Responsibility for the child? / Yes / No please circle
Home Address:(if different to child’s address): / Postcode:
Home Tel: / Mobile Tel:
Email: / Work Tel:
Name of Contact 3: / Mr / Mrs / Ms
please circle
Relationship to child: / Does this person have Parental Responsibility for the child? / Yes / No please circle
If no, does this person have Legal Responsibility for the child? / Yes / No please circle
Home Address:(if different to child’s address): / Postcode:
Home Tel: / Mobile Tel:
In addition to the above I give authorisation for the following people to pick up my child from the Club:
1) / Name: / Relationship to child: / Tel:
2) / Name: / Relationship to child: / Tel:
3) / Name: / Relationship to child: / Tel:
Class Of Their Own@Brackenbury
Registration Form
Please provide us with three contacts so that a responsible person can be contacted in an emergency and complete all sections of the form.
We are an inclusive club that welcomes ALL children but please do note down any additional needs or medical conditions your child has, that we need to know about, however small.We may be able to get additional funding for children who need additional support so the more information you give us the better.
Doctor Information
Name:
Address:
Tel No:
Does your child have an Educational Health Care Plan (EHCP) (formerly a statement)?
(This information will only be shared with Class Of Their Own staff) / Yes / No please circle
Does your child have a social worker?
(This information will only be shared with Class Of Their Own staff) / Yes / No please circle
Does your child have any additional needs? (emotional, behavioural, special educational needs, English as a second language) / Yes / No please circle
Specific Health Considerations (medical conditions, disabilities and other health needs; please provide prescribed medication if required)
Dietary Needs(food allergies and anything your child cannot eat): If your child has a severe allergy please ensure you discuss this with the club Co-ordinator prior to your child starting and provide prescribed medication if required.
Likes and Dislikes(please note down any particular interests or activities your child likes to do and also anything your child does not enjoy; please include what they do and do not like to eat - this help us to get to know your child and plan activities)
Nationality (optional): Religion(optional):
Fees and Booking Sessions
After School Club Fees
£40.00 registration fee
£12.80 per session
£12.00 per sibling
£13.80 per drop in session
£13.00 per sibling per drop in session
£59.00 for the whole week
Payments
You will receive an invoice at the start of each month for sessions within that month. Invoices must be paid within two weeks of the invoice being sent, unless a prior arrangement has been made.
Booking
Requested start date:……………………………………………………………….
For Regular Bookings, please indicate which After School Club sessions you require by selecting the box below.
Regular After School Sessions
Monday ☐
Tuesday ☐
Wednesday ☐
Thursday ☐
Friday ☐
Drop in sessions only ☐
A regular session is a pre-booked session that is the same every week.
If spaces are available you may book ad-hoc drop in spaces on a weekly basis.
Once your registration form is received, you will be sent confirmation and a welcome pack that gives you more information about the club.
The data contained on this form will be used by Class Of Their Own for the purposes of operating, administering and marketing our Breakfast, After School, Holiday Clubs and other services. Your email address will be used to email invoices, newsletters or other relevant information. Your information will be kept securely on our company database (electronically) and in the club (on paper). Your data will only be accessible to Class Of Their Own employees who need to access to it. Your personal information will not be provided to any third party for marketing purposes. None of your personal information will be passed to any individual or organisation outside of Class Of Their Own without your knowledge unless required by law.
Class of Their Own Terms and Conditions
Please read the following and complete each statement as required and sign below
•I agree to the cancellation policy: four weeks’ notice is needed to permanently cancel regular sessions, individual drop in sessions cannot be cancelled and days cannot be swapped. Holiday bookings can be cancelled or altered up to one week before the start of the holiday / ☐ /• I agree to pay the fees two weeks after the invoice is sent (Holiday Club invoices are due at the time of booking) / ☐ /
•I agree to pay a fee if I am late to collect my child (late fee is £7.50 for the first 15 minutes and 55p per minute thereafter) / ☐ /
•I agree to call the Office on 01273 733 337 or Text 07563 741 534 by 2.00pm if my child will not be attending due to illness or other circumstances and inform of the reason of absence (A charge of £3 will be added to your account if you do not inform us) / ☐ /
•I agree to NOT send any products containing nuts, or sesame products, e.g. hummus to the club with my child / ☐ /
•I agree to update Class Of Their Own of any change of personal details, contacts, health or dietary information etc. / ☐ /
•I understand that all personal mobile phones and other electronic devices are not to be used in club due to safeguarding policies / ☐ /
•All children’s and staff phones will be secured in a box when arriving at club and returned on leaving club. All devices and phones are left at owners risk / ☐ /
(please enter Yes or No):
•I agree for my child to be taken out for walks or local visits under the supervision of the Class Of Their Own Staff. (You will be informed before any outing) / Yes / No please circle
•I give permission for my child to be photographed /filmed participating in children’s activities at the Breakfast, After School and Holiday Clubs to be used only in the club,on Class Of Their Own social media and in our promotional emails and newsletters.(We will inform you if we wish to use photos for other publications, e.g. local newspaper or our website) / Yes / No please circle
•I give permission for club staff to speak to the child’s teacher about any issues relating to my child’s welfare / Yes / No please circle
•I give permission for my child to receive emergency treatment by a medical practitioner in the event of an accident and for Class Of Their Own to act in my child’s best interest in relation to consent and treatment if a parent/carer cannot be contacted / Yes / No please circle
•I give permission for my child to use sun cream provided by Class Of Their Own / Yes / No please circle
•For reception children only: - I give permission for Class Of Their Own to keep individual records (including photographs) for children in the Early Years Foundation Stage / Yes / No please circle
I agree that all information on this form is correct at the time of completion.
I have a child sibling registered at the club and paid the registration fee previouslyOR I have paid the non-refundable £40 Registration Fee / Yes / No please circle
By Cheque ☐ / By Bank Transfer ☐ / By Cash ☐
Please makes cheques payable to: Class Of Their Own Ltd and put your child’s name on the reverse.
Bank Transfer details: SANTANDER Account No: 02224163 Sort Code: 09-01-29
I, as a parent/carer of hereby enter into a contract with Class Of Their Own Ltd
For the provision of childcare as detailed in Terms and Conditions (full details of which are available on the website).