Application form

This is the application form for a Shebear Connection Centre Self Directed Learning Placement. The parent/carer is to complete an application form for each child.
Child's Details
Child’s Name *

First Name Last Name
Name child wants to be know as (if different from above):

First Name Last Name
Date of Birth *

Day Month Year
Date Date Picker Icon
Connection Centre Location *
Requested Trial Date *

Day Month Year
Date Date Picker Icon
Family and Contact Details
Primary Contact’s Name *

First Name Last Name
Primary Contact’s Mobile Phone Number *

Area Code Phone Number
Primary Contact's Email *
example@example.com

Primary Contact’s Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Secondary Contact’s Name

First Name Last Name
Secondary Contact’s Mobile Phone Number

Area Code Phone Number
Secondary Contact's Email
example@example.com

Secondary Contact’s Address if different from above

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Information about your child
Tell us a bit about your child. Likes, dislikes, preferred past-times and activities, people that are special to them, friends, places, food, and anything else you think may be relevant for us to know: *
What form of education has your child had? (Always home educated or recently de-registered? What is your approach to learning at home? Please share any experience/info that you think may be relevant: *
What interested you/your family about self directed learning, sociocratic, children’s rights based education?
What interests you about the Centre? *

Arrival and Departure

The Centre’s opening hours are from 9.30am to 3.00pm on Thursdays and Fridays. Children may attend either days or both days (providing space is available on the requested days). Attendance is not compulsory and it is at the discretion of the family what time children attend within that period.

It is recommended that children arrive as promptly as possible so they can settle in and attend the Opening Circle at 10am

At 2.30pm we will have a tidy up session and Closing Circle, ready for the end of the day at 3pm. Please collect you child/children promptly and, if for any reason you know you are going to be late please contact us.

There will be a self-sign in register for children/parents to complete on arrival and on departure.

In accordance with the Safeguarding Policy children will not be released to an unknown adult so we need to be notified via our Centre System (Cheqdin), if someone different will be collecting your child/children.
Trial Period

Children may attend up to 2 consecutive sessions to ascertain whether the Centre is suitable for them. This also gives the Adults an opportunity to see if your child will be comfortable at the Centre. The first trial sessions are Thursday 26th and Friday 27th September.

If any party considers that the Centre is not a suitable, our mutual commitment ends here and there is no obligation to complete all the second trial session. In this case a refund will be given for the second trial session.

If, the Centre and the child appear to be a good match, we will continue with the enrolment process. This decision will be made at the end of the trial sessions.

After the trial, assuming that your child/children want to join us the start date will generally be the first session of the month.
Fees

Fees are:

£20 yearly registration fee

£25 per session. There is a 20% discount for session fees if you have a Carer's Passport.

There are only 15 places available so if there are no places available and you wish to secure a place on the waiting list the registration fee is required. If there are places available then a payment for each trial (plus the registration fee, if it has not already been paid) becomes payable.

When you agree to continue with your child's/children's place/s, we will calculate how much is due for the sessions you have book for your child/children and we will invoice you. This amount needs to be paid at least 48 hours before the 1st of the month. This will continue until your child/children stops coming to the Centre.

If payment is not received then your child/children will not be able to attend. However if you have problems with payment please do not hesitate to contact us to discuss the situation as we may be able to help.
Payment Method

Currently, we only accept payment by direct bank transfer. The registration fee is required with this application form.

Our bank details are:

Account Name : Shebear Connection Ltd

Account Number : 17847561

Account Sort code : 23-69-72
The Centre uses an electronic administration system for registration, communication and invoicing. For GDPR reasons do you consent to your information being held securely on this system. *

Yes No

Agreement

We/I hereby confirm that we/I have read and agree with the Arrival and Departure, Trial Period, Fees, Notice to leave and Payment conditions. To be signed by both carers/parents if applicable.
Primary Carer’s Signature *

Clear
Date *

Day Month Year
Date Date Picker Icon
Secondary Carer’s Name

First Name Last Name
Carer 2 Signature

Clear
Date

Day Month Year
Date Date Picker Icon
Should be Empty: