Smarty's After School Club Registration Form

Smartys After School Club

Childrens after school club Hillingdon

About Us
Bookings & Fees
Breakfast club
Locations

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Which school are you registering with? *

Field End
Coteford
Ruislip Gardens

All children who attend must be registered with the club. Children remain at the club until collected by a named adult.

Child's Name *

First

Last

Name to be called *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Language spoken at home *

Ethnic Origin *

Religion *

Date of Birth *

Year and Class *

Date to start *

Days you would require *

Monday
Tuesday
Wednesday
Thursday
Friday

Parent/Guardian *

First

Last

Parental Responsibility *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Daytime Telephone Number *

Evening Telephone Number *

Emergency Telephone Number *

Does your child have any medical problems *

Yes
No

Please state below *

Is your child on any medication *

Yes
No

Please state below *

Does your child have any known allergies/objections to any food or materials, e.g. nuts, dairy products, plasters, sun cream? *

Does your child have any dietary requirements? *

Is there any food you would not like your child to eat?

Does your child have any additional needs?

Name and address of person collecting your child from the club if different from above (children will only be allowed to leave with the named person)

Name of different adult collecting *

First

Last

Telephone Number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Details of child's doctor

Name of doctor *

First

Last

Telephone Number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Any other information *

Smarty’s like to take some photos of the children while they are taking part in activities. These will either be displayed or put in a photo album to show prospective parents and OFSTED.

I agree to my child having their photo taken *

Yes
No

Do you give permission for your child’s picture to be used on social networking sites? *

Yes
No

Do you consent for information regarding any strategies the school use to be shared with Smarty’s after school club? *

Yes
No

I consent to any emergency medical treatment necessary during the running of the club. I authorise the play/care staff to sign any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child’s health and safety. *

Yes
No

Do you agree to play/care staff administering sun cream to your child when necessary? Sun cream must be provided. *

Yes
No

Do you agree to play/care staff administering sun cream to your child when necessary? Sun cream must be provided. Please bring a sunhat when applicable *

Yes
No

Do you give permission for your child/children to watch an appropriate ‘PG’ certificate DVD sometimes shown during the children’s relaxation period? *

Yes
No

There is a £5 registration fee per family which is payable at the time of registration.

Click here for our club information

Click here for the policies and procedures

I agree to adhere to Smarty's Policies and Procedures *

I agree

I agree I have read the club information sheet *

I agree

Name *

First

Last

Relationship to child *

Signature *

Date *

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