Littletown laurels breakfast and after school club registration form 2021-22
Please could you complete this if you are thinking of using either of the clubs this year.

This is so we can keep a record of all the key information we would need in case of an emergency. All registration forms need to be up-dated annually.

Please note, this is not a booking form.  
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Email *
Child's name *
Class *
As next year's classes have now been announced, please select your child's new class.
Home address including postcode *
Religion
Ethnic origin
Date of birth *
MM
/
DD
/
YYYY
Age *
Name of parents/carers and your places of work. *
Contact numbers *
Please provide as many contact numbers as possible and state for which parent/carer this is for along with if it is a mobile, work or home number.
Emergency contacts *
Please provide 2 emergency contacts. We will need their names and mobile numbers.
Named adults who are allowed to collect *
Child's doctor *
Address of Doctor's surgery and their contact number *
Known medical conditions *
Any regular medication. E.g. 2 puffs of blue inhaler when needed etc. *
Known allergies *
Can your child... *
Yes
No
Have their photo taken for publicity purposes?
Have their name printed for publicity purposes?
Have photos taken for display purposes?
Have plasters applied?
Watch PG films?
Please read this declaration for emergencies and sign your name below if you agree.
I agree to the manager of Breakfast Club and/or After school club taking the necessary to ensure that my child receives the best and most appropriate care attention and treatment should there be an emergency or accident in the provision or while my child is on an authorised outing. I understand that the manager will make every effort to inform me of any emergency or accident as soon as possible after the event but that they may, in my absence, have to accompany my child to hospital in the case of a serious accident. I give my permission from the manager to authorise Hospital Staff to administer essential treatment until my arrival.
If you don't agree with the above declaration;
I do not agree with the above declaration and I would prefer the following procedure to be followed for my child in the event of an emergency:
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