Holiday Club Registration Stevenage

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Child Details

Child’s full name as shown on birth certificate *

Any other name your child is known by

Child’s date of birth *

Gender *

phone Contacts dietary

Child’s main setting or school name *

Child’s home address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Does this child normally live at this address? *

Child’s home telephone number

Parent / Guardian 1

Parent / Guardian 1: Title

Parent / Guardian 1: First name *

Parent / Guardian 1: Surname *

Parent / Guardian 1: Home address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent / Guardian 1: Does the child normally live at this address? *

Parent / Guardian 1: Work address

Parent / Guardian 1: Home phone number

Parent / Guardian 1: Mobile phone number *

Parent / Guardian 1: Work phone number

Parent / Guardian 1: Email address *

Parent / Guardian 1: Does this person have parental responsibility? *

Parent / Guardian 2

Parent / Guardian 2: Title

Parent / Guardian 2: First name

Parent / Guardian 2: Surname

Parent / Guardian 2: Home address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent / Guardian 2: Does the child normally live at this address?

Parent / Guardian 2: Work address

Parent / Guardian 2: Home phone number

Parent / Guardian 2: Mobile phone number

Parent / Guardian 2: Work phone number

Parent / Guardian 2: Email address

Parent / Guardian 2: Does this person have parental responsibility?

Additional Parental Responsibility

Does anyone else have parental responsibility for this child? *

If yes, please provide details

Emergency Contacts

Please provide details of two people we can contact if we are unable to get hold of you.

Emergency Contact 1 *

First

Last

Emergency Contact 1 Phone

Emergency Contact 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact 1 Relationship to child

Emergency Contact 2 Name *

First

Last

Emergency Contact 2 Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact 2 Relationship to child

Doctor Details

Name of doctor

Doctor’s surgery/address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone number

About Your Child

Please detail any additional or special needs your child has

Does your child have any long-term health conditions? Yes / No

Please detail any dietary requirements or food allergies

What is the main language spoken in your family home?

Please list any languages your child is fluent in

Please give details of your child and/or family’s religion and any special requirements relating to this

Is there anything your child does not like, such as food, activities or situations?

Is there anything your child is scared of?

What are your child’s favourite activities?

Ethnicity

White British
White Irish
Traveller of Irish Heritage
Gypsy / Roma
Any other White background

Mixed White and Black Caribbean
Mixed White and Black African
Mixed White and Asian
Any other mixed background

Asian or Asian British Indian
Asian or Asian British Pakistani
Asian or Asian British Bangladeshi
Any other Asian background

Black or Black British Caribbean
Black or Black British African
Any other Black background
Chinese
Any other ethnic background
Prefer not to say

Social Care / Locality Support

Does your child or family have contact with Social Care, formerly Social Services? Yes / No

If yes, please provide brief details, including social worker name and telephone number

Is your family receiving any support from the locality team? Yes / No

If yes, please provide details, including outreach worker name and telephone number

Permissions and Consents

I give permission for sun cream to be provided and applied to my child where needed

I give permission for plasters to be used when necessary

I give permission for my child to be taken on local walks

I give permission for photographs to be taken and used for displays, publicity and media usage, including the website

I give permission for my child to watch DVDs up to PG rating

I give permission for information and records on my child to be shared with other relevant professionals, such as my child’s school teacher, where appropriate

I give permission for observations to be carried out by staff to help them plan for my child’s needs, wants and interests

I give permission for my child to attend workshops, such as art and drama, organised within school premises

Parent Agreement

We aim to have a partnership between club staff working with parents and carers to meet the needs of the children, both individually and as a group. Information to parents that must be always adhered to:

Information to parents that must be always adhered to:

Kool Kidz Club is open from 9:30am – 1.30pm Monday – Friday during school holidays.
Kool Kidz Club holds policy documents that must be always adhered to and copies are available upon request.
The group shall pass information to parents via telephone, text message, email, notice board and letters home on a regular basis and prompt action will be taken if any concerns are raised.
Staff details and information about activities are available on request.
Kool Kidz Club will undertake to consult with parents on a regular basis to ensure they are meeting the children’s needs.
Persistently disruptive behaviour by a child would result in the incidents being reviewed and recorded.
Kool Kidz Club reserve the right to exclude a child on the grounds of persistently disruptive behaviour where it affects the wellbeing of others.
Any problems which cannot be satisfactorily resolved between parents and staff may be referred to the management in line with the organisation’s complaints procedure.
All fees will be paid to Kool Kidz Club in advance of their child attending the club. We do not accept childcare vouchers. It is possible to pay cash on the day provided there are places.
Bookings for holiday club will not be refunded for any reason.
Children should be collected promptly at the end of a session. Where a parent is late in collecting a child, Kool Kidz Club reserves the right to charge a late fee, £5.00 for every 5 minutes late.
Children are not allowed to leave the group, unless accompanied by their parents or other nominated adult.
If a parent is unable to collect their child/ children, they must inform Kool Kidz Club staff. No child will be allowed to leave the premises with person or persons unknown.
Parents are requested to behave in a polite and appropriate manner when dropping off or collecting their children. Failure to do so could lead to their child being excluded.
If a parent cannot collect their child at the allocated time, they must inform Kool Kidz Club staff immediately.
All staff are aware of the need to maintain confidentiality about matters concerning families and children.
Kool Kidz Club ensures to provide a safe and caring environment free form discrimination, any discriminatory behaviour by children, parents or staff will be challenged and not tolerated.
Records will be kept containing details about the child, including health, religion and diet information, parent emergency contact details, child protection records if applicable and appropriate signed consent forms. Parents if requested to complete or sign such forms must do so promptly or your child may be refused a place.
In the event of staff sickness or emergency situations such as building fault or bad weather Kool Kidz Club reserves the right to close the setting at short notice. We will endeavour to let parents know in advance where possible.
Parents must take responsibility for their children’s belongings and teach children to do the same. Kool Kidz Club accepts no responsibility for lost or damaged property. Likewise, Kool Kidz Club staff will not spend time searching for lost or missing property.
Children must not bring in any electrical devices such as Ipads, tablets, laptops, mobile phones or Ipod’s. Likewise, no game consoles. This is in line with our use of mobile phones and cameras policy.
Kool Kidz Club staff encourage independence at a high level appropriate to the child’s age. Parents are asked to be supportive of this and support staff in teaching children about caring for each other and the setting by being responsible.
Children must bring appropriate clothes for outside play including a raincoat and shoes for wet weather and a sunhat and sun cream for hot weather. We try to go out in all weathers and unsuitable wear may mean your child being excluded from some activities.

Please tick the box below to confirm you have read and understand the parental contract agreement and recognise that by doing so you are agreeing to the contract.

Checkbox Items *

I agree to the above Parent Agreement

Emergency Medical Treatment Consent (copy)

As parent/guardian of the child named above, I confirm that, to the best of my knowledge, there is no medical or other reason why my child should not participate in Kool Kidz Club activities. I consent to any emergency medical treatment necessary during my child’s participation in Kool Kidz Club activities. I authorise the Kool Kidz Club acting supervisor to sign on my behalf any written form of request by the health service or hospital authority if delay is considered likely to endanger my child’s health and safety, and every effort has been made to contact me first.

Parent/guardian full name *

First

Last

Parent/guardian signature

Clear Signature

Final Confirmation

I confirm that the information provided is accurate and complete to the best of my knowledge, and I will inform Kool Kidz Club of any changes before my child attends.

Register

Let’s get your child registered.

A quick form so we can plan the best possible holiday for your child.

Child Details

Parent / Guardian 1

Parent / Guardian 2

Additional Parental Responsibility

Emergency Contacts

Doctor Details

About Your Child

Ethnicity

Social Care / Locality Support

Permissions and Consents

Parent Agreement

Emergency Medical Treatment Consent (copy)

Final Confirmation