L30 Centre, Stonyfield, Netherton, Merseyside, L30 0QS

Registration Forms

Main Office:

Tel No: 0151 932 9218 E-mail:

Website:

Company Ltd by Guarantee: 4201603 Registered Charity: 1091549

Dear Parents/Carers

In this pack you will find all the forms required to register your child with Fun 4 Kidz.

We appreciate that this may seem a lot of forms however, we are required by Ofsted and our funders to collect certain information and most importantly the more information we have the better we will be able to ensure we provide the appropriate care for your child.

Please use the checklist below to ensure all forms have been completed. If you require any assistance, or require this pack in large print, please do not hesitate to contact us. Forms can be returned to the club or to the main office.

We welcome you and your child to Fun 4 Kidz!

Please tick to indicate you have fully completed and returned the following forms:

Enrolment Form

Consent Form

Medical/Developmental Form

Children’s Registration Form

Parent/Carer Contract

Afterschool Club Fee Agreement (if applicable)

Breakfast Club Fee Agreement (if applicable)

Funding Form

Equal Opportunities Monitoring Form

Office Use Only:

Received by Fun 4 Kidz: Date: ………………..Signature:………………………

All forms completed as required: YesNo

Comments:

ENROLMENT FORM

Name of Child:…………………………………………………………………………………………

Address:…………………………………………………………………………………………

Postcode:…………………………………………………………………………………………

Date of Birth:…………………………………………………………………………………………

Home Tel No:…………………………………………………………………………………………

Parent/CarerName……………………………………………………………………………………….

Place of work:…………………………………………………………………………………………

…………………………………………………………………………………………

Work Tel No:…………………………………………………………………………………………

Email address: …..……………………………………………………………………………………

1st Emergency

Contact Name:…………………………………………………………………………………………

Relationship to child: ………………………………………………………………………………….

Address:…………………………………………………………………………………………

…………………………………………………………………………………………

Tel No:…………………………………………………………………………………………

2nd Emergency

Contact Name:…………………………………………………………………………………………

Relationship to child:…………………………………………………………………………….

Address:…………………………………………………………………………………………

…………………………………………………………………………………………

Tel No:…………………………………………………………………………………………

Please note that your child will not be allowed to leave the premises unless accompanied by a named person over 16.

Child’s Ethnicity: …………………………………………………….

Has this service enabled you to: (Please tick)

Stay in work

Return to work

Take up training

Other (please state) ………………………………….

Please could you detail the name(s) and address(es) of the adults who have legal responsibility for this child and their relationship to the child:

Name:…………………………………………………………………………………………………………………….

Address:…………………………………………………………………………………………………………………….

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

Relationship to Child:……………………………………………………………………………………………

Name:…………………………………………………………………………………………………………………….

Address:…………………………………………………………………………………………………………………….

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

Relationship to Child:……………………………………………………………………………………………

Please could you detail the name(s) and address of the adult who has parental responsibility for this child and their relationship to the child (i.e where the child lives):

Name:…………………………………………………………………………………………………………………….

Address:…………………………………………………………………………………………………………………….

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

Relationship to Child:……………………………………………………………………………………………

School Attended:……………………………………………………………………………………………

Tel No:……………………………………………………………………………………………

School Closing Time:…………………………………………………………………………………………….

Headteacher’s Name:…………………………………………………………………………………………….

Class Teacher:…………………………………………………………………………………………….

Name(s) of adults authorised to collect child from club:

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

Name(s) of any adults not authorised to collect child from club:

(If this person is the parent of the child the legal document stating they are not permitted access must be shown to the club).

……………………………………………………………………………………………………………………………………………

How did you find out about this service? ………………………………………………………….

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

Name: ……………………………………………………………….(Parent/Carer)

Date: ……………………………………………………………….

Consent Form

Name of Child: ……………………………………Date of Birth:……………………

Address: ……………………………………………………………………………………………………………….

Club: ……………………………………………………………………………………………………………………….

I consent to my child being given First Aid in the event of an accident

(please tick):

Yes …………………………………..No …………………………………………

(If an accident occurs whilst your child is at the club, parents/carers will be informed as soon as possible alongside the accident being recorded, you will be asked to sign this document)

In an emergency I consent for my child to be escorted to hospital and for necessary treatment to be undertaken. (Please tick)

(Fun 4 Kidz will contact you immediately should this situation arise)

Yes ………………………………….No …………………………………………..

I give permission for Fun 4 Kidz staff to assist my child in applying sun cream: (please tick)

Yes ……………………………..No …………………………………………………….

(We request that parents/carers provide sun cream for their child)

I give permission for my child to be taken out by the club during club hours to the park, library etc. (Please tick)

(Individual consent forms will be issued for day trips during the holiday club)

Yes …………………………………No …………………………………………….

Whilst at the club or on days out we will take photographs or videos of the children playing and having fun which will be used for a variety of reasons. Please tick to indicate you give permission for photographs/videos to be used for the following:

Fun 4 Kidz publicity material

Displays in club

Observations for developmental files (EYFS)

Monitoring reports for funders

Website

Data Protection: I agree for information provided regarding my child to be held on computer for Fun 4 Kidz purposes only.

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

Name: ……………………………………………………………….(Please print)

Date: …………………………………………………………………

Medical/Developmental Information

Please provide as much information as possible to ensure that we are able to meet your child’s needs and provide the best appropriate care possible.

Name of Child: ………………………………………. Date of Birth: …………………………

Address:……………………………………………………………………………………………………….

Club: ……………………………………………………………………………………………………….

Doctor’s Name: ……………………………………………………………………………………………………….

Doctor’s Address:……………………………………………………………………………………………………….

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

Doctor’s Tel No:……………………………………………………………………………………………………….

Details of

Immunisations:……………………………………………………………………………………………………….

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

Details of any

medical conditions:………………………………………………………………………………………………………

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

Any dietary

requirements:……………………………………………………………………………………………………….

Any allergies:……………………………………………………………………………………………………….

Does your child currently receive support under SEN?

Does your child currently have a statement of SEN?

Is your child registered disabled?

(SEN – Special Education Needs)

Other information (e.g. if your child requires additional assistance with specific tasks, needs specific assistance with their development or has specific dislikes)

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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

Name: ……………………………………………………………….(Please print)

Date: …………………………………………………………………

Children’s Registration Form

We would like to find out all about you so that we help to make sure you enjoy coming to our club and have lots of fun!!

Name: ______Age:______

Class: ______Teacher: ______

Names and ages of brothers and sisters: ______

Names of friends: ______

Favourite food:______

Food you dislike:______

Favourite game/toy:______

Favourite colour: ______

Favourite sport:______

Favourite TV programme: ______

Favourite film: ______

Favourite pop group/singer: ______

Name of pet or favourite kind of pet: ______

Things that upset or frighten you: ______

______

Things that you like to do: ______

______

What things would you like to do in our club?______

______

Thank You!

We look forward to meeting you and welcoming you to our club!

Parent/Carer Contract

Name: ………………………………………………………………………….

Address:………………………………………………………………………….

Child’s Name:………………………………………………………………………….

All parents/carers of Fun 4 Kidz must actively contribute and participate to support their club.

All parents/carers of Fun 4 Kidz must agree to pay fees in line with the fee agreement.

All parents/carers must adhere to the parent/carer guidelines.

All parents/carers must adhere to Fun 4 Kidz policies and procedures.

I have read the conditions for Fun 4 Kidz out of school clubs and agree to abide by them. I agree to fulfil my commitments in support of the club as a condition of my child attending Fun 4 Kidz out of school club.

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

Name: …………………………………………………………(Please print)

Date: …………………………………………………………..

Afterschool Club Fee Agreement between Parent/Carer and Fun 4 Kidz

Name of Child/ren: ………………………………………………..

Parent/Carer Email Address: …………………………………......

School Attended:……………………………………………….

Afterschool Club Attended:……………………………………………….

Childcare to start on:…../…../…..

Days: Mon / Tue / Wed / Thur / Fri (Circle as appropriate)

Child to be collected from Afterschool Club by: …………………………

Fees

Date/day fees will be paid …………………………….. monthly in advance

Afterschool £ …………. Per day£ ………………… per week

Days booked must be paid for regardless of whether or not your child/ren attends and all fees must be paid in advance or your child’s place will be closed in the club.

Each child is allowed two weeks non-fee paying holiday per year during term time e.g. if your child attends 2 sessions per week they are allowed 4 sessions per year where no charge will be made if they are unable to attend. Staff must be informed if you wish to take a cancelled session as a holiday.

If you require to close your child’s place in the Afterschool Club two weeks notice must be given.

A monthly statement will be emailed to you detailing your fee account.

Data Protection: I agree to information regarding fees being held on computer for accounting purposes only.

Signed: …………………………….(Parent/Carer)

Parent/Carer’s Name: ……………………………..

Senior Worker: …………………………………….. Date: …../…../……

Breakfast Club Fee Agreement between Parent/Carer and Fun 4 Kidz

Name of Child/ren: ………………………………………………

Parent/Carer Email Address:………………………………………………

School Attended:………………………………………………

Breakfast Club Attended:………………………………………………

Childcare to start on:…../…../…..

Days: Mon / Tue / Wed / Thur / Fri (Circle as appropriate)

Fees

Date/day fees will be paid …………………………….. monthly in advance

Breakfast Club £ …………. Per day£ ………………… per week

Days booked must be paid for regardless of whether or not your child/ren attends and all fees must be paid in advance or your child’s place will be closed in the club.

If you require to close your child’s place in the Breakfast Club two weeks notice must be given.

A monthly statement will be emailed to you detailing your fee account.

Data Protection: I agree to information regarding fees being held on computer for accounting purposes only.

Signed: …………………………….(Parent/Carer)

Parent/Carer’s Name: ……………………………..

Senior Worker: …………………………………….. Date: …../…../……

As you may be aware Fun 4 Kidz is a voluntary organisation and registered charity that relies on external funding in order to keep fees affordable. The organisation has secured funding which focuses on supporting activities that significantly improve employment and reduce worklessness.

As with all funding, monitoring has to be submitted along with evidence to back up the data, it is for this reason I am asking for your co-operation in completing the attached form. When I am submitting the information I will not be providing your child’s full name so they will not be identifiable and all other numbers will be given collectively. All information collected will be used for monitoring purposes only.

It is imperative that we receive this information so that we can secure further funding which will be of immense benefit to the future of the organisation and the delivery of the club.

If you require any further information please do not hesitate to contact me.

Thank you for your assistance and support.

Fun 4 Kidz

Child’s Name:
Club Attended:
First part of home postcode:
Date child started attending the club:
Are you entitled to receive Working Tax Credits?
Are you in receipt of Working Tax Credits?
Are you in receipt of Childcare Tax Credits:
How did you find out about the availability of these tax credits?
If you are unaware of the availability of these tax credits would you like Fun 4 Kidz to provide you with further information?
How were you made aware of Fun 4 Kidz club?
Has your child attending the club enabled you to: (please tick all that are appropriate) / Begin employment
Return to work
Stay in work
Access training
Other: (please state)

Equal Opportunities Monitoring Form

As part of the criteria for receiving funding and to ensure our services are reaching the whole community, our organisation needs to monitor the following areas of our service users.

Please note, all information received is treated with the strictest confidence.

Number of children attending Fun 4 Kidz: …………………………….

2.What club(s) will your child (ren) be attending?:

Breakfast ClubAfterschool ClubHoliday Club

3. Status. Are you?:

SingleMarriedOther

4.Are you employed?

Full TimePart timeUnemployed

Other (Please State): ………………………………………

5.Are you in receipt of any of the following?

Working Tax CreditsIncome Support

Childcare Tax CreditsDisability Living Allowance

Other (Please State): …………………………………

6.Who funds your childcare costs?:

SelfChild Care Tax Credits

CollegeSocial Services

EmployerEmployment Agency

Other (Please State): ………………………………………………………………

7.Has accessing Fun 4 Kidz enabled you to?:

Begin to workReturn to workStay in workExtend working hours

Take up trainingContinue trainingSupport familyHave time to self

Thank you for completing this form.