MPMO OUT OF SCHOOL CLUB

CHILDS REGISTRATION FORM

PLEASE COMPLETE ONE FORM FOR EACH CHILD

Please fill in this form as fully as possible to enable us to meet your child’s requirements. This form will be reviewed annually, however if any of these circumstances change, please inform us.

Name of Parent/Carer……………………………… Name of Child………………………..

Age of Child…………………………………………. Date of Birth…………………………

Childs Main Home Address……………………………………………………………………………………

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Postcode…………………………………………… Home Tel no……………………………

Mobile ……………………………………………

Place of Work……………………………………………………………………………………

Work Tel No…………………………………….

E-mail Address …………………………………………………………………………………..

Name of parents/carers with full Parental responsibility…………………………………

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Other contacts in case of emergency: (please give two)

Name……………………Relationship to child. ……………. Tel no………………………….

Name……………………Relationship to child……………… Tel no………………………….

Medical Requirements: This may include any regular emergency medication, allergies or details of medical interventions (a separate consent form will be required for medication)

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Access Requirements: This may include physical access, communication etc.

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Personal Care Requirements: This may include help with going to the toilet, eating, drinking, dressing etc……………………………………………………………………………….

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Wellbeing Requirements: This may include any specific interests or activities that they enjoy, any activities that they do not enjoy. What makes them happy or unhappy etc.

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Any other information that will be helpful in ensuring that your child has a fun and playful time at the Out of School Club: This may include any specific behaviours and their triggers ie anger, aggression, trying to run away etc. ……………………………………………………………………………………………………….

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After School Club only: Start date……………………………

School……………………………….Class……...... Teacher………………….

Monday / Tuesday / Wednesday / Thursday / Friday

Consent for Playscheme and After School Club activities

I hereby give consent for my son/daughter to visit and take part in all organised activities at More Play More Often CIC throughout the duration of their time on the playscheme. I understand that my child will be under the control of the playworkers and/or other adults approved by More Play More Often and that all the reasonable care of the children will be taken. I further understand that my child will be expected to follow all appropriate rules and regulations, and that the Leader(s) will take such action as is necessary should breaches occur.

I hereby authorise any accompanying member of the More Play More Often, to give consent to such medical treatment as is considered necessary for my child by qualified medical practitioner, during the visit/journey. This may include anaesthetic if appropriate.

I hereby give consent for the out of school club to seek medical attention if deemed necessary.

Signed………………………………………………(Parent/Carer) Date………………..

Please fill in below the name of the person/s collecting the child:

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Please notify in writing any changes to the above. We will not allow your child to leave the club with an unknown person.

I have read and understood the Out of School conditions. By signing this contract, I agree to abide by the conditions and understand that any breach could result in the loss of the childcare place.

Signed…………………………………………. Date…………………………….

Office Use Only

Form received………………………………………….

Checked by……………………………………………..

Follow up if required……………………………………

All booking/consents completed………………………

Registration Form: Y/N…………………..

Safeguarding Form: Y/N…………………

Photo Consent form: Y/N ……………….

Park VisitForm: Y/N……………………..

Medication Form (if required): Y/N………

SunscreenForm: Y/N……………………..

Intimate care Forms: Y/N…………………