Please complete and return this form to Kirstie or Vernessa of Crawley Green & Wenlock Pre-School
Children within Crawley Green & Wenlock Pre-School
Please complete this section only if you dowishyour child to have supervised access to the internet.
I have read the Conditions of the Internet Acceptable Use Policy of Crawley Green & Wenlock Pre-School. I would like my child to have supervised access to the internet.
Name of Child: ......
Name of Person with parental responsibility: ......
Signature of Person with parental responsibility: ......
Date: ......
......
Complete this section only if you DO NOT wish your child to have supervised access to the internet.
I have read the conditions of the Internet Acceptable Use Policy of Crawley Green & Wenclock Pre-School. I would not like my child to have access to the internet.
Name of Child:......
Name of Person with parental responsibility: ......
Signature of Person with parental responsibility: ......
Date:......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Fees Agreement
Please sign and return to Pre-School
I agree to pay my child's fees:
By: Cheque – made payable to Crawley Green & Wenlock Pre-School
(if a cheque is returned unpaid you will incur a chargeof £25.00 as the bank will charge us this amount. A £2.00 admin fee will be charged for each cheque paid)
Childcare Vouchers
Internet Banking – Account Name: Crawley Green & Wenlock Pre-School
- Bank: Halifax Bank of Scotland
- Sort Code: 80-11-00
- Account Number: 06060920
(Please include your child's name as reference – Thank You)
All fees are payable monthly on the 1st of the month. A deposit of one week’s fees is payable to secure a space, if this is within a month of commencement of your child’s place, a full month’s fees will be required. All future fees are then payable monthly in advance as per agreement. There will be a charge of £2.00 per day for late payments. If late payments are not received within five working days, then your child will forfeit the right to attend paying sessions without any further notice. Legal action may be taken against you for non payment of fees.
Crawley green & Wenlock Pre-School accepts no liability for any financial or other loss suffered by the parent(s), carer(s) arising directly or indirectly from the non-admittance of the child to the Pre-School for any reason, or the temporary closure of the Pre-School, this includes closures due to bad weather such as snow, plumbing issues, electrical problems and fire alarm malfunctions.
Children may on occasions attend additional clubs at school. Please note: full fees are still payable as you are paying for the space and not the attendance.
If you have a problem with making a payment or agreeing to these terms, please contact Kirstie atpreschool on 015825 727651 to make an alternative agreement.
Name of Child: ...... D.O.B: ......
Name of Person with parental responsibility......
I understand the terms and conditions of this agreement and will abide by them.
Signature of Person with parental responsibility: ...... Date: ......
General Information
As a charity run setting, we endeavour to reduce costs as much as possible. This makes sure that we put as much money into resources for the children as we possibly can. In order to help us to do this, we would like to request your permission to send out all correspondence ie: newsletters, updates etc via email. Please can you complete the slip below to confirm whether you agree or not with this process.
Child’s Name: ……………………………………………………………………………………………...... ……………………………….
Name of person with parental responsibility: ………………………………………………………...... ……………
Email address: (please insert in boxes below)
I wish to receive correspondence via email
I do not wish to receive correspondence via email
Signed: ……………………………………………………………………(person with parental responsibility)
Date: …………………………………………………………………………
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Dear Parents/Carers,
On occasions we may observe your child during their time with us (under 5’s), this helps us to build a picture of their interests and monitor their development.
We also request permission on this form to take photographs of your child that may be used for our website or advertising purposes.
There may be occasions when we need to share information with other services regarding your child such as their school or other outside agencies. We would also like to request your permission to do this.
Please could you return this form once it has been completed, signed and dated.
Thank you
Kirstie Cain
Pre-School Leader
......
I DO/DO NOT give permission for observations to be carried out on my child. I understand that on my child leaving the establishment, I will be given all the evidence. (under 5’s only)
I DO/DO NOT give permission for photographs to be taken of my child; these will be used on the pre-school website and for advertising.
I DO/DO NOT give permission to share information with other agencies/services regarding my child.
Child's Name: ......
Signed by Person with parental responsibility......
Relationship to the above Named Child: ......
Dated: ......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Breakfast and After School Club
PARENTAL CONSENT
Dear Parent/Guardian,
We require written permission to allow a member of staff from Crawley Green & Wenlock Pre-School to escort your child to/from their school.
Please complete and return the following:
I, (print name) ...... as person with parental responsibility of (child’s name) ...... give permission for staff of Crawley Green & Wenlock Pre-School to take and/or collect my child from (please delete as appropriate) Crawley Green Infants/Wenlock Junior School.
I understand this agreement will continue until I give notice in writing.
My Child is in year: ...... Class: ......
Signedby Person with parental responsibility: ......
Name: ...... Dated: ......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Breakfast and After School Club
Medical Form
Child’s Name: ...... D.O.B: ......
Address: ...... Postcode: ......
Religion: ...... Ethnicity: ......
Doctor’s Name: ...... Telephone No:......
Doctor’s Address: ...... Postcode:......
Medical Condition(s) or specific Needs. This may include hearing impairments/speech impairments/learning difficulties etc: ......
...... /......
Dietary Requirements/Allergies:......
Dentist’s Name: ...... Telephone No:......
Address: ...... Postcode:......
Name of Emergency Contact 1: ...... Tel: ......
Relationship to child: ......
Name of Emergency Contact 2: ...... Tel: ......
Relationship to child: ......
Name of Emergency Contact 3: ...... Tel: ......
Relationship to child: ......
Any other Relevant Information: ......
......
Name of Person with parental responsibility: ......
Signature of Person with parental responsibility: ......
Relationship to Child: ......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Breakfast and After School Club
Child’s Name: ...... D.O.B: ......
Please indicate in the appropriate boxes your child’s preferences of foods and drinks. Please include preferred cereal, fruits etc.
LIKES / DISLIKESCRAWLEY GREEN & WENLOCK PRE-SCHOOL
B&A ClubResponsible Adult Collection Form
We will not allow any persons to remove a child from our establishment without authorisation from the Parent/Legal Guardian of that child. Authorisation comes in the form of a password. Please ensure that if you cannot pick up your child on a particular day that you telephone during the hours of the Club and pass on the name of which you have authorised to pick your child up. Please ensure you have given the password to that contact as we will ask for it before the child is released to them. If we are not satisfied, we will contact your or one of your emergency contacts to verify that you have authorised this person to collect your child. By putting someone’s details on this form, you are authorising them to collect your child.
Please ensure you write down your password and remember it. If you need to change any details on this form please inform us as soon as possible.
Child’s Name: ...... D.O.B: ......
Address: ...... Postcode: ......
I ...... (person with parental responsibility) authorise the person/s listed below to collect my child from the After School Club on my behalf as long as I inform staff of this and the person has the correct password.
Signed: ...... (person with parental responsibility) Date: ......
(1)Name: ...... Relationship to Child: ......
Telephone Number/s: ......
(2)Name: ...... Relationship to Child: ......
Telephone Number/s: ......
(3)Name: ...... Relationship to Child: ......
Telephone Number/s: ......
Please note: if your child only attends Breakfast club, we still require a password.
My Password is: ......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Breakfast and After School Club Application Form
Child’s Name: ...... Preferred Name: ......
Male/Female: ...... D.O.B: ......
Address: (Mother/Father/Carer/Both Delete appropriate) ......
...... Postcode: ………......
Address: (Mother/Father/Carer Delete appropriate) ......
...... Postcode: ......
Contact Telephone Numbers(Mother/Carer):...... /......
Contact Telephone Numbers(Father/Carer): ...... /......
Email address:
Home Language: ...... : Ethnicity:......
Other languages spoken......
Please place a tick next to preferred method of contact: EmailPhonePost
Required Hours:
Monday / Tuesday / Wednesday / Thursday / FridayBreakfast Club / 7.45-9.00am / 7.45-9.00am / 7.45-9.00am / 7.45-9.00am / 7.45-9.00am
After School Club / 3.00-4.00pm / 3.00-4.00pm / 3.00pm-4.00pm / 3.00pm-4.00pm / 3.00pm-4.00pm
After School Club / 3.00-5.00pm / 3.00-5.00pm / 3.00-5.00pm / 3.00-5.00pm / 3.00-5.00pm
Please Note: hours are subject to availability.
Name of Person with parental responsibility: ......
Signature of Person with parental responsibility: ......
Person whom child normally lives with:......
Relationship to Child: ......
Date of Application: ...... Preferred start date: ......
Crawley Green & Wenlock Pre-School. Beaconsfield Road, Luton, Beds, LU2 0RWTel: 01582 727651
Email: website:
Permission to Share Information
We are required by law to seek permission to share information with other services. Please tick the services that you are happy for us to share information with and sign the bottom of this form. Information that we may share with schools and other services, usually relate to your child’s development. Once a year we pass your child’s progress tracker to their feeder school, this helps them to ascertain the level that they are working at in order to plan activities suitable to their needs. We are required to share information in the form of a report with your health visitor between the age of 2 and 3, you will receive a copy of this prior to it being passed over. On occasions, your health visitor may also contact us directly for information. Finally, you may or may not be involved with some of the other services, but we will usually inform you if we need to share information with them prior to doing so.
Crawley Green Infant School/Feeder School YesNo
Wenlock Junior School YesNo
Special Educational Needs Service YesNo
Health Visitor YesNo
G.P YesNo
Social Worker YesNo
Speech & Language Services YesNo
CAMH (Child and Mental Health ) YesNo
Police YesNo
Paediatrition YesNo
Please note, in the event of a safeguarding issue, we do not need your consent and are legally obliged to share information with Social Care.Should you wish to withdraw consent to any of the above, please inform us in writing.
Name of Child:...... D.O.B: ……………………………………………
Name of Person with parental responsibility: ......
Signature of Person with parental responsibility: ......
Date: ......
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Our Committee
So our Pre-School can run efficiently we need a body of committee members.
Committee meetings are held at various times of the year and they are set at times that parents/carers and staff are able to discuss ideas, progress and fundraising events etc.
We ask all parents/carers to join our committee and attend as may meetings as possible. You will be advised of when and where they will be and you will be invited to add your ideas and suggestions to the agenda.
Please remember without an active committee body, our Pre-School cannot run. The meetings are friendly and inviting with the best interests of the children at heart.
Meetings usually last no longer than one hour, and the minutes will be sent out to you all within a few days of the meeting.
Please become an active member of the committee – your thoughts, views and ideas will help our Pre-School thrive.
Many thanks.
Crawley Green & Wenlock Pre-School Committee
......
I ...... do/do not wish to join the committee of Crawley Green & Wenlock Pre-School.
My contact number is:......
My email address is:......
Preferred method of contact:(please circle) Phone email either
Signed: ......
Crawley Green & Wenlock Pre-School. Beaconsfield Road, Luton, Beds. LU2 0RWTel: 01582 727651
email: website:
CRAWLEY GREEN & WENLOCK PRE-SCHOOL
Administration/Application of Un-Prescribed Medication
Child's Name: ...... D.O.B: ......
I give permission for the Staff at Crawley Green & Wenlock Pre-School to administer un-prescribed medication to my child, as long as I have given signed consent.
Such medication includes:Calpol, Age appropriate Paracetamol, Cough Medicine, piriton etc (Please note, these must be supplied by parents/Carers)
I give permission for Staff at Crawley Green & Wenlock Pre-School to apply lotions, creams and plasters to my child as long as I have given signed consent.
Such applications include:
Plasters
Sun Lotions/Creams/Sprays, Calamine Lotion
Ointments
Hydrocortisone Creams/Topical Preparations
Other: ...... See staff for advice
I am aware that the medication will be stored according to the labelled instructions and remain in the original container. Dates will be checked and not administered if they have expired. Staff will check that the medication that I have asked them to administer is appropriate for my child. e.g. Age and quantity wise. I understand that I will not need to sign each time that any un-prescribed medication/applications are given/applied; however times will be logged at Pre-School.
I, ...... Person with parental responsibility,
(Relationship to above named child): ......
have read and understood this consent form, and given permission required. If no longer give consent after signing this form, I will inform staff in writing of this decision.
Signed: ......
Dated: ......
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