Breakfast and After School Club Registration

Home Address

Address ( If different from Parent 1)

Emergency contact

Please provide details of at least one other person we can phone if we are unable to contact you.
Name

First Name Last Name
Relationship to child
Mobile Number

Area Code Phone Number
Name

First Name Last Name
Relationship to child
Mobile Number

Area Code Phone Number

Address

About your child
Medical needs - Is your child allergic to anything? Are there any medicines that your child takes regularly?
Does your child have an dietary requirments?
Any additional information?
All accidents and emergencies are entered in the Accident/Incident Log Book.
I give permission for a member of staff to administer appropriate first aid if required.
I give permission for a member of staff to seek any necessary emergency medical advice or treatment in the event that my child is involved in a serious accident.
I expect to be contacted immediately on the above telephone numbers.
Please contact the Preschool staff for a copy of the Administering Medicines Policy; please note that to have medicines administered it must be under exceptional circumstances and prescribed by the child’s doctor,
parents are required to fill in a form which is obtainable from the Preschool staff or the school office.
I understand that the information given on this Registration Form is confidential.
I will complete a new Registration Form if any of the above details change
Signature of Parent / Carer *

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Name

First Name Last Name
Date

Day Month Year
Date Date Picker Icon
Should be Empty:

Parent / Carer details