Child's Details
Child's Full Name account_circle
Child's Date of Birth (DD/MM/YY) date_range
Child's address place
Child's postcode my_location
Child's Gender (male or female) wc
Potential Start Date (DD/MM/YY) date_range
Names of any siblings also using the club: group
School attended and Class Number school
Child's Medical Info
Doctor’s name account_circle
Doctor’s phone number phone
Doctor’s address place
Doctor’s postcode my_location
Please list any known medical problems edit
Please list any additional needs edit
Please list any medication taken edit
Please list any known allergies edit
Please list any dietary requirements edit
Please list any further relevant health information edit
Parent/Carer 1 (Bill Payer) Details
Full name account_circle
Relationship to Child person
e-mail email
Phone phone
Address place
Postcode my_location
Parent/Carer 2 Details
E-mail email
Parental Responsibilities
Please Select 'YES' or 'NO'
Does parent/carer 1 have parental responsibility?
YESNO
Does parent/carer 2 have parental responsibility?
Does anyone else have parental responsibility for this child?
If 'YES' Please provide details below
Details of Person With Parental Responsibility person
Authorised Collectors
Details of other person authorised to collect in absence of parent(s)*
e-mail address email
Phone Number phone
Security
In the event of somebody else collecting your child we require a password to release your child.
All staff are trained to ask for this password if they do not recognise the person collecting your child.
Collection Password vpn_key
Emergency Contact Details - Please Provide 2 People
Person 1
Full Name account_circle
Their Phone phone
Their e-mail email
Their address place
Their postcode my_location
Person 2
Their postcode* my_location
Child's Preferences & Permissions
Is your child permitted sweets/cakes?
Are you happy for your child to have party foods on birthdays and other festivals?
Is there anything your child does not like (food, games, etc) or is scared of? thumb_down_alt
Any special dietary requirements / food allergies? local_dining
What are your child’s favourite activities? accessibility_new
Booking Pattern & Payment
PARENTS MAY CHOOSE ADHOC DAYS FOR BREAKFAST AND AFTER SCHOOL CLUB
Concordia Breakfast Club Booking Pattern
Breakfast Club - 7am – 8.30am @ £3 per session
MonTuesWedsThursFri
Concordia After School Club Booking Pattern
3pm – 6:30pm @ £12 per session - Please tick required days
Payment Options
Please select BACS Weekly/Monthly or Vouchers
BACS MonthlyBACS WeeklyVouchers
N.B. By selecting a paymet option you are agreeing to the following terms;
- Payments to be made in advance for pre-booked contracted days
- Administration fee of £25.00 to be paid on application
- Refundable Deposit of £100.00 payable which is refunded upon 2 weeks paid notice of termination of contract
Activity Terms & Permissions
Some of the routine activities of the club may involve physical play activities, visiting parks, short trips & day trips.
Minor accidents will be expected through the very nature of participating in play.
All activities are risk assessed and properly supervised.
For your child to take part in these activities you must give your permission below;
I agree to my child taking part in the routine activities
I agree to make payment for outings & provide spending money if required.
I agree to the Co-ordinator or Manager to act appropriately in an medical emergency:
Application of Sunscreen
Children love to play outside in the sun, but sunburn in childhood increases the risk of developing skin cancer in later life.
Please select whether you will be using the Club's or providing your own sunscreen
I am happy for my child to use the sunscreen provided by the Club.I will provide a bottle of sunscreen labelled with my child’s name for use at the Club.
Photography & Video Consent
In-house Observations
In-house wall displays
School Club Website using facial images
School Club Website (Non-facial)
School Club Facebook page (Non-facial)
School Club Facebook using Facial images
Promotional literature booklets
Local press releases
General Data Protection Regulation Compliance
In order to meet our requirements under GDPR we will ensure that parents are provided with our privacy notice and data sharing agreement.
We confirm that we will not share or use your data for other purposes other than what is outlined.
*Our GDPR is available by clicking here (opens in a new window).
Please confirm that you accept the privacy notice and data sharing agreement and that you give your permission for us to contact you regarding relevant matters.
I accept the privacy notice and data sharing agreement
Terms & Conditions
*Our terms and conditions are available by clicking here (opens in a new window).
I have read the terms and conditions and agree to them
This form is from the register for Concordia page.
