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SCHOOL'S OUT WILMSLOW LIMITED
PERSONAL DETAILS
Child’s name in full :
Name usually called :
Date of Birth :
Is English your child’s first language? If not, what language does your child speak at home? :
Address:
School attended:
CARERS AND CONTACTS
Person(s) with parental reponsibility (day to day) :
Name:
Address:
E-Mail:
Contact Telephone Number:
Carer 2.
Name:
Address:
E-Mail:
Contact Telephone Number:
Person to collect child from Scheme ( if different):
Name:
Address:
Contact Telephone Number
Emergency Contact:
Name:
Address:
Contact Telephone Number
MEDICAL DETAILS
Name, address and telephone number of your child’s doctor:
Does your child have any medical problems? ________
allergies ? ________
dietary needs ? ________
special needs? ________
If you have answered ‘yes’ to any of the above, please give details below:
Anything else we need to know?:
I consent to any emergency medical treatment necessary during scheme hours. Scheme staff may authorise emergency medical treatment. Yes / No
I authorise the Scheme staff to escort my child ( if I am unavailable) to seek medical attention. Yes / No
I authorise the Scheme Staff to use hypoallergenic plasters on my child. Yes / No
I authorise the Scheme staff to administer Calpol to my child should they deem this necessary, but no more than once in any day. Yes / No
I authorise School's Out to post photographs of my child on the secure part of www.schoolsoutwilmslow.co.uk which is only accessible to currently registered families.
Yes / No
BOOKING: Please complete the current Booking Form.
If your child is not able to attend on any day booked, please notify us as soon as possible. Cancellations require a minimum of one weeks notice.
SWEAT OR T-SHIRT:
These will be given out on your child’s first session with us.
I understand that my child shall be required to wear the Sweat or T-shirt during activities within Scheme hours whilst away from the Scheme premises.
I have read agree to follow the policies and procedures of School’s Out Wilmslow Limited ( which contain terms and conditions).
CURRENT FEES: (July 2010/11 )
Full day ( 8.00am to 6.00pm) £27.00
Half-day ( 8.00am to 1.00pm or 1.00pm to 6.00pm) £15.00
Evening ( 6.00pm to 6.30pm) £ 5.00
Additional Hours (subject to availability)
Per child per hour £ 3.00
Registration charge )
Replacement t-shirts ) £ 15.00
A 10% discount is available on fees for second and subsequent children
Payment by Childcare Vouchers:
Please ask if we are already registered with your employer's chosen provider.
We are happy to register with new producers of childcare vouchers to suit your requirements. Please allow two weeks for such registrations to be processed. Bookings can be accepted before then by deposit of security cheque to be destroyed once payment has been made by voucher.
I enclose :
herewith £ by cheque /cash / paper voucher
or
proof of payment of £ by electronic voucher
in respect of my child’s attendance at the scheme during ( holiday).
This includes a Registration Fee of £ 15.00 to cover the costs of the SCHOOLS OUT WILMSLOW LIMITED SWEAT OR T-SHIRT
Signed Parent/ Carer:
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