Off Grid Kids After School Club Registration
Childs Name *
Your answer
Date of Birth *
Your answer
Address *
Your answer
Postcode *
Your answer
Age when starting with us: *
Your answer
Start date *
MM
/
DD
/
YYYY
School Attending (After School Club) *
Your answer
Class - when starting with us *
Your answer
Class Teacher Name *
Your answer
Main Carer’s Name – will be main contact for Off Grid Kids *
Your answer
Home Address & Postcode *
Your answer
Best Contact Telephone Number *
Your answer
Email *
Your answer
2nd Carer’s Name *
Your answer
Home Address & Postcode *
Your answer
Best Contact Telephone Number *
Your answer
Email *
Your answer
In the event of an emergency, please contact the following person in the first instance. *
Your answer
Please list 2 other people authorised to collect your child & can act as emergency contact:
Person 1 - Name *
Your answer
Best Contact Telephone Number *
Your answer
Person 2 - Name *
Your answer
Best Contact Telephone Number *
Your answer
Your secret password is (this is used as a safe word if your child is being collected by any unauthorised persons) *
Your answer
GP Name *
Your answer
GP Address & Postcode *
Your answer
GP Telephone Number *
Your answer
Days required: *
PLEASE SELECT APPROPRIATE DAYS, SPACE WILL BE CONFIRMED ONCE PAYMENT IS RECEIVED
Required
Payment Information:
We will forward you an invoice for a non-refundable registration fee, please contact us if you wish to use childcare vouchers.
About Your Child
Any allergies or conditions that require regular medications? A separate medication form is required *
Your answer
Activities likes and preferences
Your answer
Has your child missed any of their tetanus injections (part of the regular NHS childhood vaccination program)? *
What to avoid?
Your answer
Anything else we should know? (We have a separate form for children with additional support and learning needs)
Your answer
Please tick below to confirm that you agree to photograph/video footage of you or your child being used in Off Grid Kids publications, FB and website *
Emergency Treatment - Please confirm that you authorise that in the event that your child requires immediate medical attention that Off Grid Kids may sign on your behalf in the circumstances when Off Grid Kids have been unable to contact you. *
Please confirm that you are happy for us to apply insect repellent - midges can be annoying *
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