Hurleybirds Registration
Please complete this form, ensuring all information is correct. If you need to register more than one child, please complete a form for each child. Thank you.
Sign in to Google to save your progress. Learn more
Email *
Name of child (Last name, first name, e.g Smith, Alex) *
Date of birth *
MM
/
DD
/
YYYY
Address *
Postcode *
Parent/Carer's Name (1)  (Last name, first name) *
Parent/Carer's Name (2)  (Last name, first name) *
Parent/Carer (2) Home Telephone Number
Parent/Carer (2) Work Telephone Number *
Parent/Carer (2) Mobile Telephone Number *
Parent/Carer (2) Email Address *
Additional Emergency Contact 1  (Last name, first name) *
Additional Emergency Contact 1 Relationship to the child
Additional Emergency Contact 1 Number *
Additional Emergency Contact 2  (Last name, first name) *
Additional Emergency Contact 2 Relationship to the child *
Additional Emergency Contact 2 Number *
I/We consent to any emergency medical treatment necessary during the running of the club. I authorise Hurleybirds' staff to sign a written form of consent by hospital authorities if the delay in obtaining my signature is consider by the doctor to endanger my child's life. *
At Hurleybirds we are here to provide a safe, stimulating and enjoyable environment for your child/children between the hours f 7.30am - 8.45am and 3.30pm - 5.30pm Monday - Friday (except school and Bank holidays).

Please note, however, that when school closes at 2.00pm or for any other reason, Hurleybirds does not operate on those afternoons either.

We ask that you read the following conditions and sign to say that you have read and understand the terms we have set out.

Terms and Conditions

Payment:

I agree to:-
1.) Pay a fee of £5.00 per hour per child, siblings £3.00 per hour, per sibling
2.) There is a minimum payment of £4.00 for morning sessions, siblings £3.50.
3.) Payment must be made by the end of the week and by no later then one week after the billing date
4.) Cash or bank transfer is our preferred method of payment - ask a member of staff for details. Cheques payable to 'Hurleybirds'. A receipt will be issued.

Parental Duties

I agree to:-
1) Pick up my child/children on time( if you are running late, please phone to let us know). Any late pick-ups after 5.30pm will incur an additional cost of £25.00 to cover extra staff wages.
2.) Let Hurleybirds know if there is a change of person picking up my child prior to pick-up.
3.) Let Hurleybirds know if there is a change of personal details, e.g contact numbers, address.

Duty of Care

I agree to:-
Give consent to allow staff to make decisions regarding my child's welfare if a parent or emergency cannot be contacted (ie if your child has to go to hospital).

I have  read, understood and agree to all the terms and conditions above as set out by Hurleybirds.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ICT Development Service. Report Abuse
Google Forms