PT Childcare Club > Registration

Registration Form

Name of Child:
Which club would you like to register for?:

Catterick - Holiday Club
Catterick/ Colburn - After School Club
Date:
Previous Names:
Likes to be called:
Age:
Childs Home Address:
Date of Birth: *
Previous Address:
Home Phone:
Daytime Phone:
Mobile Phone:
Email Address:
Child's School:
Please supply the names of all parents with parental responsibility for your child:
Name 1:
Name 2:
Name 3:
Name 4:
Please supply the names of 2 adults who will be collecting your child:
Name 1:
Address:
Phone Number:
Relation to Child:
Name 2:
Address:
Phone Number:
Relation to Child:
Emergency Contact:
Name:
Address:
Telephone Number:
Mobile Number:
Relation to Child:
Has your child ever ben included on the child protection register:

Yes No
Please detail any relevent court orders in place, including thos which affect any person's access to the Child's (e.g. Residence Order, Contact Order, Care Order) Injuncition etc):
Does your child have any learning difficulties, disabilities or any other special needs?:
Are there any other factors which may impact on your child's safety?:
Is there any further information about your beliefs or faiths you would like to share with us to assist us in making your child's stay at PT Childcare Club happy, safe and positive?
Please provide us with details about any previous care facilities your child has attended:
Please tick as appropriate:

Yes, I agree to pay monthly or weekly in advance. Bank details 30-91-73 16009768
Yes, I give permission for PT Childcare Club to seek any records or evidence of any orders from previous child care facilities.
I give consent for PT Childcare Club to take photographs of my child for internal assessment records.
I give consent for these photos to be used in press and marketing material
Signature (Print Name):

Medical Form

Child's Doctor:
Name:
Address:
Telephone:
Does your child have any known medical problems? If so, give full details.:
Does your child require medication prescribed by a doctor, to be give during club times?:

Yes
No
If yes, please arrange to record this in the Medicine Book with the Club Manager:
Is your child allergic to anything:

Yes
No
If yes, please provide details:
Does your child have any major dislikes eg. certain foods or materials?:
Consent for Emergency Medical Treatment:

I consent to any emergency medical treatment for my child necessary during the running of the club. I authorise the playcare staff to sign any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child's health and safety.
Please tick appropriate:

Yes
No
Form Completed by:
Relation to Child:
Additional Medical Information:

Parent and Carer Contract

Name of Parent / Carer:
• I understand that PT Childcare Club/PT After School Care is a play care facility and that whilst my child is there PT Childcare Club/PT After School Care is legally responsible for him/her.
• My child will be provided with breakfast, snacks, fruit and drinks whilst at the Club unless otherwise requested.
• I understand that PT Childcare Club/PT After School Care cannot refrigerate packed lunches and care must be taken with items provided. An insulated lunch box should be used whenever possible.
• My child will be given stimulating and challenging play opportunities in a fun and safe environment.
• Once my child is delivered to/collected by PT Childcare Club/PT After School Care he/she will be in the care of PT Childcare Club/PT After School Care until collected by a named responsible adult.
• I will inform PT Childcare Club/PT After School Care by email, text or verbally if another person will be collecting my child. During the school holidays a password system will be in place and I understand I am responsible for passing on the relevant password to the different adult and notifying PT Childcare Club/PT After School Care by phone, text or email.
• I give consent for my child to be transported in vehicles used by PT Childcare Club/PT After School Care staff. I have seen the relevant Risk Assessment.
• I understand that PT Childcare Club/PT After School Care has a Mobile Phone and Camera Policy and that this Policy applies to children who arrive in the club with their own mobile phones, cameras or internet connecting devices.
• I will book into the Club 24 hours in advance and will pay for my booking in full to secure my place. I understand that this is non-refundable if I cancel the booking.
• I understand that if my child has been sick or had any incidents of diarrhoea they should not be brought into PT Childcare Club/PT After School Care for 48 hours following the last incident.
• It is my responsibility to keep the PT Childcare Club/PT After School Care informed of any alterations to information regarding my child.
• I accept that whilst at PT Childcare Club/PT After School Care my child may get involved in messy activities and will provide my child with appropriate clothing to accommodate this. I also understand my child must wear trainers / plimsolls.
• PT Childcare Club/PT After School Care closes at 6pm and if for any unforeseen circumstances I am going to be late, I will contact PT Childcare Club/PT After School Care on 07864 018610 / 07591 744853 / 07591 744853 / 07864 018610 / 07790 607705 to inform them.
• If my child is not collected by 6pm. I will pay a charge of £10 per quarter of an hour to cover the costs of the two staff that are legally required to stay.
• If any child remains at 7pm, after doing everything possible to contact parents and emergency contacts, then PT Childcare Club/PT After School Care will be legally required to contact Social Services.
• Whilst we try to ensure the safety and security of items, we cannot be held responsible for anything lost or stolen.
• I have read the Behavior Policy and agreed to its terms and appreciate that in some circumstances it may be necessary to exclude my child from the Club and I will pay for these missed sessions.
• Should there be any incidents at PT Childcare Club/PT After School Care involving my child, then I will be informed of the situation.
• If my child has an accident, he/she will be treated by a qualified first aider and I will be informed of the situation as soon as possible. If there is a situation where my child needs urgent medical treatment and I am unavailable, a member of staff from PT Childcare Club/PT After School Care may sign any consent forms necessary for treatment on my behalf.
• Any information and details regarding my child will be treated as confidential. However there may be times, for example in case of child protection concerns, when details of my child may be passed on to other agencies, for example Police, Social Services and Health Care Professionals.
• Where the Club has endorsed my claim for Childcare Tax Credit, PT Childcare Club/PT After School Care is legally obliged to notify the Inland Revenue if I cease to use the service during the period of my claim unless I give a minimum of 10 days’ notice. Reference to your Tax Credit Claim form will indicate we may be held jointly liable for any claim the Inland Revenue consider to be fraudulent.
• I understand that all PT Childcare Club/PT After School Care Policies are made available at all times in the foyer for perusal by parents.

I have read and understood the above terms and conditions and I agree to abide by them.

Getting to know you better

To help us make their time with us as enjoyable as possible, please could you take a minute or two to complete this table with your child/ren. Many thanks.

When your child is at home what do they enjoy doing?
What is your child's favourite book character and TV programme? What does your child play on a computer, ipad, DS, Xbox etc?
What plans to you have for your next holiday?:
Are there any toys and games that your child particularly likes? E.g. Lego, dolls etc:
Is your child interested in any particular films at the cinema?:
Is there anything significant happening in your child's life at present? E.g. Birthdays, weddings, new pets etc.
Please feel free to tell us anything else about your child that will help us make their time with us a really enjoyable time for them

Consent Forms

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