Langford Village Community School

Registration Form

Please complete the registration form for your child and ensure you have read the terms and conditions (these can be found in the 'Terms and Conditions' tab), thank you:

Details of child:

Child's Name:

Child's Date of Birth:

Gender:

Class Teacher:

Home Address:

Parent/Guardian details:

Mother/Guardian Full Name:

Address if different from above:

Contact Telephone Numbers (please provide at least two numbers):

Email Address:

Do you have legal parental responsibility for the child?

Father/Guardian Full Name:

Address if different from above:

Contact Telephone Numbers (please provide at least two numbers):

Email Address:

Do you have legal parental responsibility for the child?

Emergency Contact Details (other than named above in the event we cannot get hold of you, who is able to collect your child if necessary):

(1) Name:

Address

Telephone Number:

(2) Name:

Address:

Telephone Number:

Medical information about your child:

Name of Doctor:

Address and Telephone Number:

First Aid Consent

I give permission for first aid to be carried out on my child by a trained first-aider:

I give my permission for the use of plasters:

If you have any medical information the club should know about, please give details:

Circumstances you think may affect your child (eg medical, learning difficulties, factors at home):

Medical History/Medical Allergies:

Food Allergies/Dietary Requirements:

Session Requirements:

Half Breakfast Club (8.00am - 8.45am, no breakfast) Full Breakfast Club (7.30am - 8.45am, includes breakfast which is served between 7.30am - 8.00am)

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Half After School Club (3.15pm - 4.30pm) Full After School Club (3.15pm - 6.00pm)

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Who will collect your child (any changes in person(s) collecting must be given to the Staff):

Password:

Emergency Contact Number (1) - please provide name and contact number for the first contact:

Emergency Contact Number (2) - please provide name and contact number for the second contact:

Permission

During the course of some Breakfast and After School Club activities, a camera may be available for staff and children to use. It is now necessary to obtain parental permission for photographs to be taken of the children. All photographs taken and printed will be available to parents/carers. Photographs used will not contain any reference to the child's identity etc.

I give permission for photos to be taken/used on school displays/school website/brochure:

I give permission for my child to use forms of media ie DVDs:

I give permission for my child to use computers including access to the internet:

Do you give permission for your child to have their face painted/hand painted:

Do you give permission for local village walks (information provided before it takes place):

For Reception Children ONLY (Applying sun cream provided by parent/guardian in a named bottle.)

I give permission for staff at the setting to apply sunscreen to my child:

I understand this information will be stored and that Parents/Guardians are responsible for advising the Breakfast and After School Club of any changes.

A registration fee of £10 must be paid with this registration to secure your child's place.

To pay via BACS:

Sort Code: 30-00-02

Account No: 00969317

Account Name: OCC Langford Village Comm DR CR

Reference: Please put your child's name as the reference

I have read the terms and conditions:

Parents Name: