Registration – Elm Cottage

Your name *

Your Last Name *

Registration Email *

Password *

Do you want to register more than 1 child? (optional)

Child’s Full Name *

Child’s Date of Birth *

Child’s Gender *

Child’s Current School *

Child’s Year/Class (reception- Y6) Children must currently attend school/home school. We are not suitable for nursery school children. *

Children’s Full Names (comma seperate in age order) *

Children’s Dates of Birth (comma seperated in age order) *

Children’s Genders (comma seperated in age order) *

Children’s Current Schools (comma seperated in age order) *

Child’s Years/Classes (comma seperated in age order) (optional)

Child’s Nationality *

Child’s Ethnic Background *

Child’s First Language *

Please specify if your child has any Additional Needs *

I give consent for us to discuss your child with teachers (Senco) about how their day has been (in school/Club) for any help or support your child may need whilst in our care. (optional)

Any special Dietry Requirements or Health Concerns *

Parent/Carer 1 Full Name and Relationship to Child *

Title *

Parent/ Carer 1 Home Address *

Parent/ Carer 1 Postcode *

Parent/Carer 1 Mobile Number *

Parent/Carer 1 Email Address *

Parent/Carer 1 Home Number (optional)

Parent/Carer 1 Place of Work and Phone Number *

Parent/Carer 2 Full Name and Relationship to Child *

Title *

Parent/Carer 2 Home Address (if different from parent/carer 1) (optional)

Parent/ Carer 2 Postcode (optional)

Parent/Carer 2 Mobile Number *

Parent/Carer 2 Email Address *

Parent/Carer 2 Home Number (if different from parent/carer 1) (optional)

Parent/Carer 2 Place of Work and Phone Number *

Please state who has Legal Responsibility of your child *

Please State which is the Childs Permanent Residence *

I understand that I am the person responsible for ensuring my child arrives at club safely, & I understand that ELM COTTGE LTD cannot be responsible until my child has arrived safely at club premises & greeted by staff on site. *

I understand that as I am the parent/ carer who is enrolling my child, I am the person responsible for payment of fees. All sessions must be paid for in full before attending the Club. TFC payments must be cleared. *

I understand that If I wish to make any changes or cancel sessions, I must put them in writing via email to Elm Cottage. I understand that if I don’t give 7 days’ notice of cancellation, I will still be charged the full price. *

I understand that if I don’t give 7 days’ notice of cancellation of sessions via email, I will still be charged the full price. *

Authorised person(s) to collect my child. Please list 3 names. *

If any of the 3 named persons are unable to collect my child, I understand it is my responsibility to inform the club manager of another suitable person. *

Contact for Failed Collection (other than parent/carer 1/2). Name, Number *

Consent gained for named person(s) *

I agree to ensure my child is collected by the end of the booked session. *

I understand that if my child is not collected by the end of a booked session & we have not been informed of any delay, that Elm Cottage will inform the police that your child has been abandoned with us as stated in our safeguarding policy. *

First Person to Contact in an EMERGENCY *

Back up EMERGENCY Contact *

If my child should require emergency medical attention whilst in the care of Elm Cottage and I cannot be contacted, I give my consent for such medical attention to be given. *

I understand that in the event that my child should require emergency medical attention whilst in the care of Elm Cottage, my child accompanied by a staff member will be taken to hospital in an ambulance or taxi immediately for emergency treatment or advice. I will be informed of the incident and meet my child and staff member at the hospital. In other circumstances I understand that I will be asked to collect my child from the club premises, and take them to hospital *

Childs Doctors Details *

Are there any other Professional’s involved with you child or family? (optional)

I give consent for hypo-allergenic plasters to be applied to my child if necessary. (optional)

I give permission for my child to be given 2.5ml of Piriton in the event of an allergic reaction. (optional)

I give consent for the manager in charge or designated deputy to administer, one 5ml spoonful of Paracetamol Suspension, In the event of my child developing a high temperature, according to the procedure as stated in the Elm Cottage Medicines Policy. (optional)

I request for my child to be cared for by all staff at ELM COTTAGE, during the designated sessions *

I understand I will need to provide a packed lunch for my child if the session falls over lunch time at 12pm. *

To minimise allergic reactions we kindly request that packed lunches or snacks contain no traces of NUTS. Please check food labelling. This contains all nut spreads. *

I give consent for my child to watch any ‘U’ or ‘PG’ rated DVD’s/Videos under the supervision of a play worker. (optional)

I give permission for face paints to be used on my child. (optional)

I give permission for glitter/ temporary tattoos to be used on my child. (optional)

It is my responsibility to apply suncream in warm weather prior to any booked session along with a summer hat. To also provide warm out door clothes for any cold or wet weather. *

I give my consent for photographs to be taken of my child to be used on our official Elm Cottage out of school club website www.elm-cottage.com and Instagram page elmcottage.kidsclub Or for any promotional posters. (optional)

I give consent for my child to be photographed for display purposes. (optional)

I give permission for my child’s art work along with their first name to be displayed around the setting and on our official website and Instagram page. (optional)

I give permission for my child’s first name and days of attendance to be shared with other parents of the setting E.g. For party lists or friendships (optional)

I give my consent for information regarding my child to be handed over to other outside agencies E.g. Hursthead/Didsbury Road School/Shared with Ofsted upon inspection. This will consist of a summary of their time at our club and any additional needs your child may have. (optional)

Children or persons who do not behave appropriately will be asked to leave. Club does not tolerate, whether a child, parent, carer or visitor: bullying; aggressive, confrontational or threatening behaviour; or behaviour intended to result in conflict. Club is a place of safety and security for the children who attend and for the staff who work here *

I have read the Elm Cottage Medicines Policy, Safe Guarding Policy and Data Protection Policy and accept the policy as stated *

* To read our policies please click here.