Liscard Pirates Club - September 2020

Admissions Form - new starters to Liscard Pirates Club

Pirates Club to re-open in September 2020

In accordance with the latest guidance, Liscard Pirates Club will be able to provide before and after school care in two main 'pods' (Pirates and Captains), for a limited number of children.

Should you wish to book a place for your child, please complete and submit this registration form as soon as possible to secure a place for your child.

Regrettably, we are unable to provide a holiday club this summer due to insufficient interest.

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* 1. Child's details:

Name:

Date of Birth (DD/MM/YYYY)

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* 2. Named to be used at the Club:

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* 3. Gender:

Male

Female

Prefer not to say

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* 4. Ethnicity:

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* 5. Religion (if any):

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* 6. Languages:

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* 7. Names and Contact Details of Parents/Carers (those with parental responsibility)

Parent/Carer 1 Name:

Parent/Carer 1 Contact No/s.:

Parent/Carer 2 Name:

Parent/Carer 2 Contact No/s.:

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* 8. Child's Home Address:

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* 9. Any other emergency contact details?

Additional Emergency Contact 1 Name (& relationship to child):

Emergency Contact 1 No/s:

Additional Emergency Contact 2 Name (& relationship to child):

Emergency Contact 2 No/s:

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* 10. Please list names of the few people who are authorised to collect your child from Pirates Club:

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* 11. Doctor's Contact Details:

Name:

Surgery:

Surgery Address:

Surgery Contact No:

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* 12. Health Visitor, if applicable

Name:

Contact No.:

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* 13. Please give details of any significant health issues (including any special educational needs and/or disabilities statement):

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* 14. Please give details of any special dietary requirements, allergies or significant food or drink preferences:

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* 15. Record of immunisations (including dates):

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* 16. Do you consent for members of staff at Pirates Club to apply sun cream to your child in hot/sunny conditions?

Yes

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* 17. Please provide any other relevant information:

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* 18. I hereby consent for my child to take up a place at Liscard Pirates Club, according to the terms and conditions set out in its policies and procedures. I have understood the expectations and obligations relating to both myself and the Club and agree to abide by them.

I understand that persistent late or non-payment of fees will jeopardise my child's continued attendance at Liscard Pirates Club.

I confirm that the information given above is correct and I promise to contact the Manager as soon as any of the details change.

Yes

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* 19. Completed:

Parent/Carer Name:

Date (DD/MM/YYYY):