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Early Years Registration Form
Westbourne  Park Family Centre, Westbourne Park Baptist Church, Porchester Road, London W2 5DX
Tel. 020 7727 6019, Charity No. 1085070

Please fill out the registration form.  Many thanks.                                                                      
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Your Name
Relation to Child *
Email
Address *
Postcode *
Which ward do you live in?
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Home Tel:
Mobile
Which Groups would you like to attend when we are back open?  We will contact you to advise what is currently available.
Column 1
Tuesday - Music making 1 (10:00-10:45)
Tuesday - Music making 2 (11:15-12:00)
Wednesday - Families only (10:00-12:00)
Thursday - Play Session (10:00-12:00)
Friday - Create and Play (10:00-11:00)
Friday - Messy Church (11:00-12:00)
Parenting Support 1:1
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How did you hear about us?
Name of Child *
Name of Second Child *
Child's Date of Birth
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Second Child's Date of Birth
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Child's ethnic Background
Child's gender
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Second Child's gender
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Are you a single parent?
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Does your child have a disability?
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Do you have a disability?
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Parent/Carer ethnic background
Column 1
White-English/ Scottish/ N.Irish/ UK
White-Irish
White-Gypsy or Irish Traveller
Any other white background
African
Carribean
Other ethnic group
Any other Black/African/ Carribean
Mixed Ethic background
Indian
Pakistani
Bangladeshi
Chinese
Arab
Prefer not to say
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Parent/Carer ethnic background
Column 1
White-English/ Scottish/ N.Irish/ UK
White-Irish
White-Gypsy or Irish Traveller
Any other white background
African
Carribean
Other ethnic group
Any other Black/African/ Carribean
Mixed Ethic background
Indian
Pakistani
Bangladeshi
Chinese
Arab
Prefer not to say
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Parent/Carer age
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Parent/Carer first language
Parent/ Carer gender
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Parent/ Carer sexual orientation
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Parent/Carer religion
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As a Charity,  WPFC has a focus on supporting families on low income. Do you receive benefits?
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Do you ever struggle to pay bills or have to cut back on food shopping? *
Required
If you have answered yes, you are eligible to shop at the Westbourne Food Pantry every Thursday.  You can become a member by going to https://www.yourlocalpantry.co.uk/westbournepark/ and choosing London Westbourne Park in the drop down menu.
Do you feel financially stressed?
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Data Consent
Westbourne park Family Centre will keep your details secure and not share them with any other organisation without your consent.  If you have any questions or want your data changed at any time, contact: info@westbourneparkfamilycentre.org.uk
Do you give permission for these details to be used anonymously as part of an evaluation of our services and their impact?
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We occasionally take photographs for promotion and funding purpose. Do you give us permission to do this
Would you like to receive email updates on upcoming events and opportunities from Westbourne Park Family Centre, Paddington Development Trust and Creative Futures?
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Are you interested in volunteering to suport these sessions?
COVID 19 Terms and conditions

Arrival at WP Venue:
The front doors will remain secured and everyone arriving will have to buzz for entry
The right hand door only will be used for entry, unless the double doors need to be opened for access of a pushchair, wheelchair or a delivery.
If groups are arriving together, people will be asked to queue outside, maintaining the required social distance of a minimum of 1 metre for external areas
Reception staff and volunteers will be provided with face shields as personal protective equipment (PPE)
People arriving will be asked if they are unwell or have any symptoms of COVID-19, which will be on display as a reminder.  Anyone who does will be requested to return home and follow NHS guidance on self-isolating.
One person or household group will be able to enter at a time
Everyone arriving will be asked to:
o wear a mask (not needed for children)
o Wash their hands
o Sign in with their name and contact number, explaining this to enable ‘track and trace’ should this be needed
o Pens used for signing in will be wiped before next use.

Circulating around WP Venue:
All building users are requested to use the hand gels that are available throughout the building on a regular basis
The lift can be used by one person, or one household group at a time. The lift can be used for access to all floors with priority given to those who need it for accessibility or who are moving items between floors
The staircase will mainly be used to go down to and up from Meeting Level and Hall Levels. Social distancing needs to be in place on the staircases, with each person or household maintaining a distance from each other.  Stair handrails will be cleaned regularly throughout the day
Multiple groups in areas will arrive and leave at different times to limit contact throughout the day.
Doors will be propped open throughout the day to avoid the need to touch door handles or door plates.  Where this is not appropriate, for issues of privacy or safety, door handles will be cleaned regularly throughout the day.
Activities within WP Venue:
Social distancing guidance needs to be adhered to at all times, with no physical contact, including hand shaking/hugging for anyone outside a household group  
Regular hand washing / sanitising will be encouraged for all attendees
Attendees to wear face coverings whilst in the general areas of the  building, but should avoid touching these
Use of gloves is not recommended for people attending activities as they reduce handwashing and can create a greater risk of transmission of germs
Chairs and mats will be arranged for activities dependent on the individual activity risk assessment. These must not be rearranged, as they will have been planned to meet social distancing requirements.
When adults are sitting on mats/chairs then face masks can be removed.  2 families groups can share one mat.  
Children can play as normal and socially interact with other children.  
There can be no food preparation/sharing until guidance is changed, so no cooking on the premises.  People can bring their own snacks/food, but these cannot be shared.
Hot and cold drinks can be provided, but only following individual activity risk assessment which needs to be discussed with a member of the WP Venue staff to ensure safe practice.

Use of toilets:
The toilets will be cleaned regularly throughout the day
Antiseptic wipes will be available within the toilet cubicles and users are requested to wipe the toilet seat following use and dispose of the wipe in the bin. Please do not flush down the toilet
Handwashing, using the soap provided, for a minimum of 20 seconds following use of the toilet is essential
Use of paper towels to dry hands thoroughly is requested.
(Awaiting guidance on use of hand dryers)
The ladies and gents toilets on the Hall Level will be restricted to one person or one household group using them at any one time, due to the difficulty in socially distancing when washing hands

I understand the above statement and agree to the above terms
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