Kingslea Primary School, Kings Road, RH13 5PS

Rocketeers Registration Form

CHILD DETAILS

First name: / Click or tap here. / Last name: / Click or tap here. /
Known As: / Click or tap here. / Gender: / Click or tap here. /
Birthdate: / Click or tap here. / School: / Click or tap here. /
Religion: / Click or tap here. / Nationality: / Click or tap here. /
Ethnicity: / Click or tap here. / Language / Click or tap here. /

Please complete the following table, indicating the sessions you require.

Session / Mon. 12 February / Tues. 13
February / Weds. 14
February / Thurs. 15
February / Fri. 16
February
Long Day - £35.00
7:30 a.m. – 6:00 p.m. / ☐ / ☐ / ☐ / ☐ / ☐ /
Short Day - £28.00
9:00 a.m. – 4:00 p.m. / ☐ / ☐ / ☐ / ☐ / ☐ /
Lunch – £2.50
Check if required / ☐ / ☐ / ☐ / ☐ / ☐ /

Please put a tick in the box by the days you would like to book. We will provide breakfast and snack as part of the daily cost. We will supply lunch for £2.50 extra per day but you are more than welcome to provide a packed lunch. Please state in the box above if you would like us to provide lunch.

To secure your child’s place at Rocketeers Holiday Club, we require immediate payment upon receipt of invoice. This can be paid by electronic transfer, see bank details below. Please put your child’s name as a reference against any payments made.

Bank Account Details:

Rocketeers

Santander

09-01-28

86852198

We also accept Childcare vouchers, just let us know what scheme you are part of. These can take up to 5 working days. Please bear this in mind.

Contact details:

01403 371020

PARENT/GUARDIAN DETAILS(required)

First name / Click or tap here. / Last name / Click or tap here. /
Relationship / Click or tap here. / E-mail / Click or tap here. /
Address / Click or tap here. / Postcode / Click or tap here. /
Mobile # / Click or tap here. / Home # / Click or tap here. /
Secret Word / Click or tap here. /

PARENT/GUARDIAN DETAILS

Emergency contact (required)

MEDICAL INFORMATION (required)

Doctor: / Click or tap here. /
Surgery Address: / Click or tap here. /
Surgery Number / Click or tap here. /
Does your child have any known medical problems or additional needs? / Yes/No /
If yes, please detail. / Click or tap here. /
Does your child take any medication? / Yes/No /
If yes, please detail. / Click or tap here. /
Does your child have any known allergies? / Yes/No /
If yes, please detail. / Click or tap here. /
Does your child have any dietary requirements? / Yes/No /
If yes, please detail. / Click or tap here. /
Is there any otherinformation you’d like to share about your childs health? / Yes/No /
If yes, please detail. / Click or tap here. /

If my child is involved in a serious accident, I expect to be contacted immediately on the telephone numbers given.

Should my child require immediate medical treatment before I can get to the hospital, I hereby authorise the staff member to consent to any emergency medical treatment necessary to ensure the health and safety of my child, on my behalf.

Click or tap here. /
PARENT/GUARDIAN – please sign & date

PHOTOGRAPH CONSENT

As the parent/guardian of this child I give Rocketeers permission to take photograph and/or video of my child. (click for YES) / ☐ /
As the parent/guardian of this child, I give Rocketeers full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications. (click for YES) / ☐ /
I only give permission for my child's picture etc. to be used for club use such as observations, planning and development. (click for YES) / ☐ /
Click or tap here. /
PARENT/GUARDIAN – please sign & date

SUNSCREEN CONSENT

As the parent/guardian of the above child, I recognize that too much exposure to UV rays may be dangerous. Therefore, I give permission for the staff at Rocketeers to apply FOREVER LIVING sunscreen, with a SPF 15 or higher to my child when s/he will be playing outside, especially during hotter months. I understand that sunscreen may be applied to exposed skin, including but not limited to the face, tops of ears, nose, bare shoulders, arms and legs.

Click or tap here. /
PARENT/GUARDIAN – please sign & date