Kookaburras Forest School
This form is a booking in form for Kookaburras Forest School
(at Bolney Under Fives).
Kookaburras Forest School operates on Mondays between 1:15 and 3:15pm
Sessions cost £8.00 each and payment is required in advance.
(introductory offer £5 per session)
Date of Birth *
Child’s Forename *
Email address
Tel No and Work No *
Emergency Contact Details : Full Name *
School/Pre-school Provision Attending *
Child’s Surname *
Full Postal Address *
Doctor’s Full Name and Tel No *
Notes on any medical conditions, allergies, administration details and/or special needs (Please include as much information as possible). *
I give my consent for the administration of basic first aid treatment by qualified first aid staff and give my consent for my child to be taken to hospital in case of an emergency, providing I am immediately advised of this action. *
In the outdoors environment we will be in there are a number of possible allergens. Children's allergies are often unknown until they become exposed to a possible allergen for the first time. Therefore as part of our first aid kit we have Piriton syrup and Wasp-Eze. In the event of an allergic reaction our first aid training dictates that it is essential for us to administer these precautionary medications immediately. We therefore seek your permission to do so. *
In the event of the above being administered the child's primary emergency contact will be telephoned once the dose has been administered with full and relevant information.
Parental Responsibility *
Please include all who have parental responsibility of the above child ( Full Name, Address, Postcode and Tel no)
I understand that on arrival for each session all children must be accompanied by a parent/carer until they have been signed in. *
I understand that unless requested, children should not bring valuables or any money. Bolney Under Fives take no responsibility for lost or stolen valuables. *
I understand that continuous, disruptive and unacceptable behaviour by any child will result in their removal from the activities without refund. *
I accept that children should be appropriately clothed for participation during forest school sessions. *
Declaration...... I have read, understand and agree to the terms and conditions of Holiday Club at Bolney Under Fives. I have disclosed any medical information which will be needed by Bolney Under Fives Holiday Club staff. I give my consent for photographs and video materials of my children to be used. *
please initial and date
Terms and Conditions
The following are the terms and conditions for your child whilst attending Bolney Under Fives Kookaburra's Forest School

Parents of all children who wish to attend will be required to complete a registration form prior to admission to the sessions.
The Kookaburras Forest School fees are £8 per session (£5 introductory rate when booking for 6 sessions commencing 15th September 2014)
Registration 1:10pm Collection 3:15pm in the Bolney Under Fives Barn.
please supply a drink in a bottle.
Places are allocated on a first come first served basis.
Fees must be paid in full before attending.

Fees are payable for all booked and additional sessions. Fees are payable in advance either by cash, cheque made payable to Bolney Under Fives or BACS, in person at preschool or posted to –
The Treasurer
Bolney Under Fives
Bolney Under Fives Barn
Bolney Wine Estate
Foxhole Lane
RH17 5NB
A receipt will be issued.

Please telephone the Preschool Leader to inform them that your child will be absent from the session on either 01444820054 or 07922092259.

Health & Safety
To ensure the safety of all children who attend we require the name of the person/s that will be collecting your child from the session or any persons who have parental responsibility. This information will be required on the registration form. Please note that we will not hand over any child without prior permission and may contact you to clarify this person’s identity.
It is important that we are fully informed and aware of any changes in your child’s health. Should your child become unwell or incur an injury in our care every effort will be made to contact the parent/carer. Where your child has shown symptoms of vomiting and/or diarrhea they should not return to Bolney Under Fives until 48hrs after their last symptoms.

Signing In and Out
Bolney Under Fives cannot accept responsibility for your child until 1:15pm, parents/carers must remain with their child until this time.

Failure to Collect Policy
In the event your child is not collected at 3:15pm from the reception area, a series of charges will apply as follows. The first 15 minutes or part of will be charged at a flat rate of £5.00, and then £1 for every 5 minutes until collection is made.

Personal Property
Whilst every reasonable care will be taken, Bolney Under Fives cannot be held responsible for any loss or damage to a child’s property. We request that children’s own toys are not brought into the club.

Suitable Clothing Policy
Suitable clothing and footwear must be worn. Jewellery is not permitted in any circumstances.

Behaviour Management
Everybody is encouraged to treat each other with care and respect and behave in a manner this is acceptable. Children who attend BU5s are supported to develop a Code of Conduct which is displayed within the building. It is our policy that all staff are treated with respect and that behaviour is managed within a positive framework. Bu5s Kookaburras Forest School policies and procedures should be adhered to by all participants. Failure to adhere to the Kookaburras Forest School Code of Conduct may result in exclusion from the Kookaburras Forest School without refund.
Continuous unacceptable behaviour will be challenged by staff and recorded in the incident book. Parents will be asked to sign this entry.
If the behaviour does not improve then BU5s has the right to forbid the child from re-attending.
Where a child is continually violent, disruptive or bullying the parent will be asked to keep the child away for an agreed period of time.
When children and /or their parent display behaviour likely to cause offence BU5s reserves the right to refuse or withdraw the immediately.

Cancellation of Place
If your allocated place is no longer required no refunds can be made. Fees are non returnable or transferable if your child does not attend for any reason.

Childcare Vouchers and Tax credits
Bolney Under Fives are able to accept childcare vouchers. Contact HMRC Government 0345 300 3900 for tax credit childcare enquiries.

Ofsted registration number EY472141 .

Complaints Procedure
If you or your child is unhappy with the service or the staff, please discuss your concerns with the club leader. Your concerns will be treated with respect and confidentiality or contact. You can also
email your concerns to info@bolneyunderfives.co.uk. You can also make an official compliant to Ofsted telephone 0300 1231231.

Photographs and Video consent
At Kookaburras Forest School we like to celebrate all children’s achievements and value their contribution they make to the group. Photographs make interesting displays for children, parents and visitors to look at, and may also be used in local or national newsletters and in some cases local and national press.
When a child attends the group the parent/carer and child will be asked for permission for photographs to be taken. Every parent and child has the right to refuse this request, in which case the child will not be photographed.
Where pictures are made available to the press or television, they will not be released with the names of the child unless the contracting parent gives express permission for this to be done.
If you give your permission to use photographs and video material, these may be used in the following ways to promote the out of school club
In printed publication
Displays in centre
BU5S Website
Facebook page

Never submit passwords through Google Forms.
This form was created inside of BOLNEY UNDER FIVES. Report Abuse