Child Information Form for After School Club and Holiday Camps
Child's Name
Does your child have a name he/she likes to be known by?
Sex
Home address
Home Telephone number
Child's Nationality and Languages spoken
Child's current class at school
Please give child's religion
Please give details of any disabilities
Is there anything special you feel we need to know about your child?
Please give the name of first Parent/ Carers
Relationship to the child
Address of first parent / carer
Contact Telephone Number
Email address
Address of work place
Please give the name of the second parent / carer
Relationship to the child
Address of second parent or carer
Contact Telephone Number
Email Address
Address of work place
Do the parents / carers noted above have full parental responsibility for the child
Clear selection
If you answered no to the above question please give details
Name of a 1st emergency contact (Must be different from above )
Relationship to the child
Contact telephone number
Name of a 2nd emergency contact
Relationship to the child
Contact telephone number
Please give details of any health conditions
Please give details of any allergies
Please give details of any dietary requirements
Address of GP surgery
The following people are authorised to collect my child.
Please give or refuse the following consents and authorisations. My child to go on supervised outings while attending after school club sessions and camps
Clear selection
For emergency medical treatment to be given when necessary
Clear selection
For suncream to be applied in hot weather
Clear selection
For Culham After School Club LTD permission to take and display photographs. These may be used to promote Culham After School LTD via our website / social media / printed material.
Clear selection
Terms and Conditions. It is the responsibility of the parent / carers to notify us of any changes in school pick up arrangements *
Parents and carers are requested to pay invoice in advance and by the requested date, failure to do so could result in booked sessions being offered to another child. *
If arrangements for paying fees are made with a third party e.g Employer / college etc. that this arrangement is personal to you and the responsibility remains with yourself to settle your child's account. *
Your Name *
Date *
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