Registration form
Your child cannot attend Emmer Green after school club until this form has been returned to the Club manager
Child’s Full Name:	Ethnic Origin:	
Name to be called:	Year group:	
Date of Birth:		Gender:	

Please provide a password here, this will need to be given to anyone you have authorized to collect your child up from the club:…………………………………………………………………. 

Emergency Contact Numbers (between 3.00pm and 6pm i.e. while child is at Club)
	Name	Relationship to 
Child	Work address/
occupation 	Telephone Number(s)	
1					
2					
3					
4	Dr	Family Doctor			

We will not allow children to attend the Club unless we have at least 2 contact numbers for them other than that of their doctor.
Please give details as appropriate in each section below:
Known medical problems		
Medication which may 
need to be taken at Club		
Allergies		
Special dietary requirements		

Child’s home address:		
Who does the child live with at this
address (parents, siblings, etc.)?		
Home telephone number:		

Preferred email address. 		
Preferred Mobile number/s to be used
For our texting service		
Addresses of parents/guardians 
(if different from above)		
Is there anybody who is not allowed
 to have contact with the child?
 If so, please give name and
 relationship to child.		

Who will be collecting the child from the Club? N.B. For your child’s protection, we will not allow 
the child to leave the Club with anybody who is not listed below (or who we have not be advised in advance
 by the parent/carer will be doing so, and without ID to confirm who they are).	
Name	Relationship to child	Telephone # 3.00pm to 6.00pm	

			

So that the Play workers can provide activities with the needs of the individual children attending the Club in mind, they would be grateful if you would provide the following information. Please note that this information will be treated as confidential and will be held securely.
Does your child have any special
needs, educational or otherwise?		
Does your child have any hobbies
or specific interests?		
What would you like your child to
gain from attending the club?		

Do you give EGASC permission to share photos of your children on our Facebook page?	Yes/No*
*Please delete as appropriate	
Are you happy for your child to be taken on accompanied trips around the local area? (park, shops, duck pond etc)	Yes/No*
*Please delete as appropriate	

Is there anything that the After 
School staff should know 
about your child ?

EGASC is run by a management committee made up of parent volunteers and we are always on the look out for new members. We hold termly meetings and members can participate as much or little as they like. 

Without a committee EGASC can not run. 

Please detail any skill/knowledge that you may have which may be of help to EGASC. I.e.         
Legal background, HR.

Please speak with a staff member if you have any questions or would like to join our committee.  

I do/ do not give permission for my child to be photographed (This is a chance for you to see what activities take place while your child is in our setting, all photographs and camera will be kept in a locked cupboard and will only be displayed to the after school club's parents and children)

I consent to any emergency medical treatment necessary while my child is under the care of Emmer Green After School Club. I authorize the staff of EGASC to sign any written form of consent required by the hospital authorities if the delay in getting the signature of the parent/guardian is considered by the doctor to endanger my child’s health and safety. 
Information held by EGASC regarding my child will be treated as confidential. However, in certain circumstances, for example if there are child protection concerns, I understand that the club has a legal duty to pass certain information on to other agencies, including Police, Social Care and health care professionals
By signing this registration form you are agreeing to all EGASC policies and procedures

Signed ______________________________________    Print Name _________________________________
Date________________________________________
The personal information you provide EGASC with on this registration form and throughout your childs time at the club is stored securely at EGASC premises and is only accessible to EGASC staff and when necessary to the Management Committee. From time to time we will need to contact you via phone, email and teachers2parents texting system, to provide you with EGASC updates, send your invoices, or speak to regarding your child. 

Ticking this box confirms you have read and understood the above statement and that you have read and agreed to the Privacy notice and Child Details Policy