REGISTRATION FORM FOR OUR OUT OF HOURS ACTIVITIES

This form launched in July 2014, it only needs to be completed once to cover future activities.Just update us if anything changes. Once this form is complete, you can book our activities simply by completing a booking form for each activity.

Please return a signedcopy of this form to Sports Camp, Canterbury High School, Knight Avenue, Canterbury, Kent, CT2 8QA.

Please complete in BLOCK CAPITALS and circle as appropriate.

ABOUT YOUR CHILD

Name:
Date of Birth:
Gender:
School attended:
Home address and postcode:
Email address:
Medical conditions, including allergies and food intolerances: / Please use the space below to provide us with full details and advice regarding these issues so that we can support appropriately where possible.
Behavioural/learning conditions:
Please note that while we do all we can to support children with difficulties, we cannot always accommodate all needs or all individuals where a combination of needs exists in a group.

PERMISSIONS

We require all our under 14s to be signed in and out for our activities.
Do you give your consent for your child to sign themselves in and out for our activities?
If NO, please provide a password which we will require if someone other than you collects your child / YES
They would be allowed to leave without an adult collecting them.
NO
Password:
………………………………………………….
Add the email address you provided to our activities database? / YES/NO
May we photograph/film your child taking part in our activities?Occasionally we may need to photograph or film your child for the actual activity, as in during some media, performing arts and other activities. / YES/NO
May we use photos/video (unnamed) for publicity such as our activity leaflets or our websites? / YES/NO
I consent to my child visiting off-site locations as part of the activity.
Occasionally there are activities available offsite that may form part of our programme. These will be organised in accordance with our Educational Visits Policy and you will be made aware of them at the time of booking. / YES/NO
I agree to my child using equipment appropriate to the activity / YES/NO
My child can receive Calpol/Paracetamol as appropriate, if needed / YES/NO
My child is safety conscious in water / YES/NO
My child can swim 50 metres / YES/NO
My child is fit to participate in activities / YES/NO
My child is confident in the sea / YES/NO
I understand that KCC does not provide personal accident cover / ______(please initial) (applies to Youth Team activities for ages 13+)

IN AN EMERGENCY

In the unlikely event that something goes wrong while your child is with us, we want to be able to get in touch as soon as possible. Please advise us of any changes to these details.

Contact priority / Emergency Contact Name / Emergency contact number/s / Relationship to young person named on this form:
1st
2nd
3rd

You may wish to provide further emergency contacts; if so, please attach details to this form on an additional sheet.

ALLERGIES & MEDICATION

Please ensure any allergies your child has or medication they are on are listed on the first page and keep us up to date with any new medical condition/s your child develops.

EMERGENCY CONSENT
I agree to my child, NAMED HERE: ...... , receiving medication and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.
If I am unable to be contacted in an emergency, I agree that transport can be arranged to take my child to the relevant medical authority, if deemed necessary by the staff in charge. I have the authority to provide permission for this child and it applies to all future activities my child may attend with The Canterbury Academy.
Signed:
Print Name:
Relationship to young person:
Date:
BEHAVIOUR POLICY
Children’s behaviour must not compromise the safety or enjoyment of themselves or others at any time. Should a child’s behaviour become inappropriate, they may be encouraged temporarily to sit out of the activity. If the leader of the activity feels the child is unable to adjust their behaviour, the parent or emergency contact will be contacted to collect them. Where this is the case, no refund will be given and, in extreme circumstances, the child might not be able to return to the activity or to attend future activities.
Young people attending trips which involve minibus travel must behave appropriately, considering the safety of themselves and others at all times, this includes the wearing of seatbelts. Behaviour offsite is also always expected to be of a high standard.
We do all we can to support all children to access our activities but where children have particular needs or there is a combination of needs within a group we may not be able to provide the support that they require.
DATA USE
By booking on to our activities you understand that the information provided will be used for monitoring and evaluation purposes and the production of statistical reports to inform effective provision of a range of youth hubservices and you give permission for the youth hub to share this information with its partner agencies for the purposes of delivering its services only.
Any information given on the booking and registration forms is kept confidential and will not be passed to organisations outside of the youth hub partners without consent, unless it is of a child protection nature, in which case information will be shared with appropriate agencies. The youth hub undertakes to keep all information provided in a secure location.
This form will be kept for the purpose of emergency contact details and information will be stored on the electronic database (eStart) until the child’s 25th birthday. You agree for the information supplied on this form to be held on the Early Help eStart Database and that this information will only be shared in accordance with the Data Protection Act 1998 and The Children’s Act 2004 Information Database (England) Regulations 2007. Further information on data protection can be found on or

CHECKLIST

I have provided all relevant medical information for my child.
Where my child has a medical, learning, food or behavioural issue I have provided full advice and details.
I have provided at least two valid emergency contact details and they understand that they have been listed for this purpose and may be contacted in an emergency to collect or attend to the young person listed.
I have signed the medical consent clause.
I have answered all of the consents listed on the permissions page and I have understood and agree to the behaviour policy and data use notification.
I will update The Canterbury Academy Holiday Activities team in writing if the details in this form change or if there is anything else they should know.