Register | Vicky's Clubs

Are you Registering for a Breakfast & After School Club or Holiday Club?*

Breakfast & After School Club

Holiday Club

Which School Club?*

Child's Name*

First Last

What do they like to be called (if different)?

Date of Birth*

School Attended*

What Year Group Are They In?*

First Language*

Parent or Guardian*

Title First Last

Home Address*

Does the child normally live at this address?*

Yes

No

Work Address

Mobile Number*

Home Number

Work Number

Email*

Does this person have parental responsibility?*

Yes

No

Does the child have a second parent or guardian?*

Yes

No

Second Parent or Guardian*

Title First Last

Do they live at the same address given above?*

Yes

No

2nd Parent or Guardian Home Address*

Does the child normally live at this address?*

Yes

No

Mobile Number*

Home Number

Work Number

Email*

Does this person have parental responsibility?*

Yes

No

Does anyone else have parental responsibility for this child?*

Yes

No

Please give further details*

Please provide details of two people we can contact if we are unable to get hold of you.

Emergency Contact One

Name*

Mobile Number*

Other Number

Address*

Relationship to Child*

Emergency Contact Two

Name*

Mobile Number*

Other Number

Address*

Relationship to Child*

Collection Password

In case a different adult is collecting your child please provide a password that they can use for us to verify them.

Collection Password*

What Doctors Surgery is your child registered at?*

Doctor's Name

Surgery Address*

Telephone Number*

Does the child have any known medical problems, additional needs or a requirement to take any medication?*

Yes

No

Please give further details.*

I give permission for Calpol to be administered in an emergency.*

Yes

No

I give permission for Sun Cream to be applied when necessary.*

Yes

No

Please detail any dietary requirements or food allergies.*

Is there anything your child doesn't like (food, games etc.) or is scared of?*

What are your child's favourite activities?*

The use of photographs is an important developmental tool that is widely used in play and educational settings for recording, sharing and displaying activities that your children have undertaken. At Vicky’s Holiday Club we take the issue of child protection very seriously and we would never knowingly publish an image of your child without your consent.

As the parent or carer of the child named below, I grant permission for images of my son or daughter to be used for the following purposes:

Electronic and printed displays and exhibitions at the Club (eg photos of activities)
Observation and assessment
Club records of my child
To accompany staff or student coursework
Website for Club
Promotional material for the Club
Local newspaper or magazine
National newspaper or magazine
Other organisation’s website
Other organisation’s promotional material

I understand that personal details or names of any child in a photograph will never be given in such a way that would allow them to be individually identified.

I understand that this image will NOT be used for anything which may be viewed as negative in tone or that may cause offence, embarrassment or distress for the child or their parent or carer.

I understand that there will be no payment for my child’s participation.

I grant permission as outlined above*

Yes

No

Contract With Parents

I consent for my child to attend Vicky's After School & Holiday Club. I understand that the club has policies and procedures (which are available for reference at the club), and that there are expectations and obligations relating both to the club and to myself and my child, and I agree to abide by them.
I understand that Vicky's After School & Holiday Club is a play setting and that whilst my child is there Vicky's After School & Holiday Club is legally responsible for him/her.
My child will be provided with a snack and drink whilst at the club unless otherwise requested.
Once my child arrives at Vicky's After School & Holiday Club, he/she will be in the care of Vicky's After School & Holiday Club until collected and signed out by an authorised person.
I will notify the club before the start of the session if I am collecting my child from school on a day that he/she is booked to attend the club. I understand that I will be charged for the booked session.
I will book my child into the club on a termly basis and will pay within 7 days of receiving the invoice. I will pay for all booked sessions whether my child attends or not (e.g. due to illness or holidays), unless I have made other arrangements with the manager.
If I wish to cancel my place at Vicky's After School & Holiday Club Ltd then I will give a terms notice for After School Club and two weeks notice for Holiday Club bookings. Holiday Club bookings cancelled after this period will be charged for the full amount due.
It is my responsibility to keep the club manager informed of any alterations to the information regarding my child (e.g. Contact details, medical conditions, etc).
I accept that my child may take part in messy activities while at Vicky's After School & Holiday Club. I understand that I can provide my child with appropriate clothing to accommodate this if I wish.
Vicky’s After School Club closes at 6.10pm. If, due to unforeseen circumstances, I am going to be late, I will contact the manager/deputy as soon as possible.
If I do not collect my child by a quarter of an hour from the time my child is due to be picked up or quarter of an hour after the club closes if they are there until the club closes, I will pay a charge of £7.00 per quarter of an hour to cover the costs of the staff who are legally required to supervise my child.
If I do not collect my child by 30 mins after they are due to be collected and the club has been unable to reach me or any of my emergency contacts, I understand that Vicky's After School & Holiday Club Ltd will follow it's Uncollected Children Policy and contact Social Care.
Whilst Vicky’s After School Club tries to ensure the safety and security of items, I understand that it cannot be held responsible for loss or damage to my child’s property whilst at the Club.
I have read the club’s Behaviour Management Policy and agree to its terms and appreciate that in some circumstances it may be necessary to exclude my child from the club, and I will pay for any missed sessions unless otherwise agreed with the manager.
If there are any accidents or incidents at Vicky's After School & Holiday Club involving my child, I will be informed.
If my child has an accident at the club, he/she will be treated by a qualified first aider and I will be informed as soon as possible. If my child needs urgent medical treatment and I am unavailable, a member of staff from Vicky's After School & Holiday Club will sign any consent forms necessary for treatment on my behalf, as stated on the club’s Medical Form.
Information held by Vicky's After School & Holiday Club 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.
I understand that aggressive and abusive behaviour towards staff will not be tolerated.

Name of Person Completing This Form*

Would you like a copy of your completed form emailed to you?*

Yes

No

Which email address would you like it to be sent to?*

Registration Form

Register for one of our Clubs

Contract With Parents