LEEDS MENCAP and JOHN JAMIESON EAST SILC PLAYSCHEME

LEEDS MENCAP and JOHN JAMIESON EAST SILC PLAYSCHEME

11th to 15th April 2016

Ages 9 to 13 years

Information sheet 2015/16

We are pleased to advise that we will be running a5day playscheme at John Jamieson East SILCfrom Monday 11thApril to Friday 15th April 2016.The playscheme is for children and young people who were aged between 9 and 13 years on 1st September 2015 (the playscheme is open to 9 to 18 year olds who attend John Jamieson’s East SILC).

There area limited number of places which can only be booked through submitting a completed application form. The charge for attending the playscheme is£15 per day or £75 for a full week.

Payment methods:

• Cheques should be enclosed with the application and made payable to: Leeds Mencap
• Payment can be made by BACS transfer to:

Name:Leeds Mencap

Sort code: 20-48-46

Account number: 83934683

Reference:[your child’s name] / playscheme

• Cash on the first day of playscheme

In order to ensure we have sufficient planning time, please be advised that the last date for applications will be Sunday 27th March 2016. We will not be able to accept applications after that date. Confirmation of places will be sent out in early April along with an outline of activities for the week. No young person will be accepted on the day without prior booking.

The playscheme will start at 10.00 am and finish at 3.00pm. Young peoplewill need to bring a packed lunch and a drink with them every day as well as appropriately clothing for the activities and weather.

If your child cannot attend due to illness please contact the Playscheme leader’s mobile on 07525 115258. Unfortunately we are not able to refund payment for days which children do not attend because of illness.

Please return all forms and payment to:

Leeds Mencap

Londesboro Terrace

East End Park

Leeds

LS9 9NE

Please retain this sheet for your information.

Leeds Mencap. Registered Charity No. 1091809 and Company Limited by Guaranteed No. 4332965.

Registered Offices: Leeds Mencap, Londesboro Terrace, East End Park, Leeds, LS9 9NE.

LEEDS MENCAP PLAYSCHEME – AGES 9-13

11th- 15thApril 2016

It is very important that we can contact you if needed so please make sure mobiles are switched on and contacts available.

Childs Details:

Name

D.O.B

Address

Please tick which days you would like your child to attend

Monday
11th April / Tuesday
12thApril / Wednesday 13th April / Thursday 14th April / Friday
15th April / Amount
£

Payment Method (cheque/BACS/cash):

Emergency contacts (Please give two, including parent / carer)

1.Name:

Relationship:

Contact Number:

2.Name:

Relationship:

Contact Number:

Parent/ Carer details:

Name

Address

(if different from child)

Email Address:

Please tick if we can use your email address for sending out information about:-

Leeds Mencap Groups only Other groups for people with learning disabilities

Home Telephone Number:

Mobile Number:

Medical Information

Doctors Name:

Address:

Telephone Number:

Does your child have a medical condition that requires medication?

YESNO

If yes, please give details of condition and any medication required below.

Please label all medication clearly with child’s name, dose and times given

If your child has complex medical needs, please contact us.

Does your child have a diagnosis?

YESNO

If yes, please provide details

Does your child use a wheelchair?

YESNO

If yes, please provide details

Does your child have any allergies?

YESNO

If yes, please provide details

Toileting:

Does your child require assistance or reminding to use the toilet?

YESNO

If yes, please provide details of what assistance is required or how they prefer to be changed.

If your child is incontinent, please supply nappies/pads, wipes and cream.

Communication:

What form of communication does your child use? E.G. speech, gestures, makaton, pecs, etc.

Language spoken at home:

Behaviour

If your child exhibits any challenging behaviour, please explain how this is managed.

If your child becomes upset how do they like to be comforted?

Does your child require 1:1 care?

YESNO

If yes, please provide details

Diet:

Does your child have any special dietary requirements?

YESNO

If yes, please provide details

Does your child need help with feeding?

YESNO

If yes, please provide details

Likes & Dislikes:

We may be taking the children out on trips to farms, parks and museums (such as Eureka) and other places of interest. Is there anything we should be aware of when taking your child out?

What kind of activities/toys does your child like?

What kind of activities etc. does your child not like? Is there anything that might upset them?

We wish to ensure that your child’s needs are met at playscheme and a great deal of time is spent ensuring we have the right staffing levels, suitable activities and trips to ensure that the children’s needs are met and that they have lots of fun with us at playscheme.

Please provide any further information - which will help us to ensure that your child’s needs are met during their time at playscheme. (Please continue on separate sheet if required)

Consent

I hereby certify that the information given on this form is correct, and -

I give my permission for playscheme staff to:

Administer first aid if needed?

YESNO

To seek medical advice or treatment?

YESNO

To take trips outside of the playscheme building?

YESNO

To go swimming?

YESNO

Please indicate the level of swimming ticking one or two items below.

Non-swimmer limited swimmer must use armbands good swimmer

Signed

Print Name

Date

Equal Opportunities

Please fill out the next section in order to record the ethnic origin of play scheme attendees. Any information you provide will be kept confidential.

Please tick

White British
White Irish
Traveller of Irish Heritage
Any other White background
Gypsy/Roma
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background
Indian
Pakistani
Bangladeshi
Any other Asian background
Caribbean
African
Any other Black background
Chinese
Any other ethnic group

Behaviour management policy

• All children and young people and their families will be treated fairly and with respect.
• We will support and encourage all children and young people attending activities to treat each other with kindness and respect.
• We understand that children and young people with additional needs sometimes experience the world and those around them differently and this can affect their responses. Our aim is to support them in responding appropriately to situations and to help them behave in a way that promotes enjoyment of the activities for them and those around them.
• We will work with parents/carers to understand how their child behaves and the different behaviours that they can exhibit when upset, anxious and happy.
• If a child or young person has a behaviour management plan in use at school Leeds Mencap will ask to see the details, with the parents/carers permission, so that staff and volunteers can manage behaviour in a consistent manner.
• All staff and volunteers will be made aware of any particular triggers to behaviour that might be difficult to manage and techniques for de-escalating challenging behaviours.
• Positive interactions and behaviour will always be rewarded and praised.
• Children and young people will not be labelled, shouted at or told they are bad or stupid.
• In all cases staff will use de-escalation techniques to try to calm or settle a child/young person or distract them with another activity. Physical intervention or restraint of a child or young person will only be used in exceptional circumstances.
• If a child or young person’s behaviour escalates to a level at which they are at risk of harming themselves or others or they are distressed over a long period of time and are unable to settle and cannot be reassured, Leeds Mencap may ask parents/carers to collect their child/young person.
• Parents/carers will be consulted as a situation develops in order to prevent the child/young person needing to be collected if possible.

I have read and understood this behaviour policy

Signed Date

Photography/Filming consent form

Name of person to be photographed/filmed:

This person is a:

Service user / which service? / Playscheme
Parent/guardian/family member of service user / which service?

Leeds Mencap requires photographs, voice and video recordings in order to show a positive view of the organisation, its employees, volunteers and people that use its services.

I consent to all future collection, storage and use of photography, video and voice recordings of the above named person from the date stated below.

I understand that any images or recordings may be used by Leeds Mencap at any time, both now and in the future. This may include the use of these images/recordings:

-On displays within Leeds Mencap’s building

-In Leeds Mencap’s services leaflets, newsletters and other publications

-On the Leeds Mencap website and social media pages (e.g. Facebook)

-In fundraising literature

-In publicity and fundraising features in the press (e.g. newspapers)

-In promotional videos

I accept that I will not be paid or be provided with a different service by Leeds Mencap or its partners as a result of being involved in recordings or photography. I will not own the copyright.

By signing this consent form I agree to all of the above.

Name of consent-giver and relationship to person being photographed:

Contact phone/email:

Signed:Date: