Booking Information- October Half Term Holiday Club 2024
Booking available for all Children Aged 4 - 11 years 

8:00am-5:00pm £36.00
9:00am-3:30pm £26.00
(Snacks/Drinks available throughout the day.)

Note; Your Child will need to bring a Packed Lunch.

Location:  Chase Terrace Primary School, Rugeley Road, Burntwood, Staffordshire, WS7 1AH

Please complete ALL the information below including the day(s)/session (s) you would like to book a place for your Child. Upon completing the form, you will receive email correspondence/invoice. Thank you.

We will use this information under lawful legitimate interests for funding, invoicing and general correspondence.

*Please note- Upon receipt of your booking form and session(s) required, all bookings will be invoiced accordingly. Any cancellations will incur a cancellation fee. 

We look forward to seeing you there!
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Email address - We will send all correspondence including your invoice to the email address stated. *
Please select the day(s) and session (s) you would like to book below.
9:00am-3:30pm
8:00am-5:00pm
Monday 28th October
Tuesday 29th October
Wednesday 30th October
Thursday 31st October
Friday 1st November
Children's Registration Form

We need some details about your child and family. We have a legal obligation to collect and process this information in accordance with The Early Years Foundation Stage (Welfare Requirements) Regulations 2012 and therefore we do not require your consent for the first section of this form. Where information to be supplied is voluntary or where we do need consent, this is identified. The information provided will be kept in paper form and used for the purpose of maintaining appropriate contact details and for the safety and well-being of your child.



Child's full name *
Date of birth *
MM
/
DD
/
YYYY
Gender *
Name and home address of parent(s) with whom the Child lives: *
Parent/Carer 1- Full name and contact number. Include work contact details. *
Parent/Carer 1 - Do you have parental responsibility for the Child? *
If no: Do you have legal contact?
Clear selection
Parent/Carer 2- Full name and contact number. Include work contact details. *
Parent/Carer 2- Do you have legal responsibility for this Child? *
If no: Do you have legal contact?
Clear selection
Siblings and their age (Leave blank if not applicable)
Details of any other adults living in the home address named above. (Leave blank if not applicable)
Name of Parent(s) with whom the Child does not live with? Please leave blank if not applicable. Where this information is applicable please include the following detail - Does the Parent have Parental responsibility? Does the Parent have legal contact? and Does the Parent have legal access to the Child? Address of the named person including contact details.
Emergency Contact details
Please provide the names and contact details of 2 people.( other than Parents/guardians) who we can contact in case of an emergency. NOTE: It is your responsibility to ensure the people listed below are happy for us to hold their details and contact them.  
Emergency contact 1- Include full name, Contact telephone numbers and relationship to the Child *
Emergency contact 2- Include full name, Contact telephone numbers and relationship to the Child. *
Security details; A password system operates in our setting. A secure password is required and should be used by emergency contacts and persons authorised to collect your child. Ideally this should be one word and something that is easily memorable. Please do not use obvious things such as middle names. The password is required from anyone collecting your child. If they do not have the password we will not release your child to them. ( it could be your child’s date of birth)My secure password is *
Any person authorised to collect Child
Persons authorised to collect the Child. This can be any other adult who may collect your Child in your absence. Authorised persons must be over the age of 18 years old.
 Please give Name(s)s, contact details and relationship to the Child of all person(s) authorised to collect your Child. *
Additional security information
We have the safety and well-being of the children in mind at all times and we are sure that you will appreciate that persons known to you are strangers to us and we do need means of identifying those you have authorised to collect your child (either authorised or emergency contacts) when you are unable to.

We as a setting and especially your child/children key person will be familiar with you but we do not always have the opportunity to meet both parents. This is also true of your nominated emergency contacts and authorised persons. We therefore request that should anyone unknown to us be collecting your child that you inform us in advance and ensure that they are aware of your password.

Health information - Please tick which vaccinations your Child has received *
Required
Does your Child suffer from any of the following? *
Required
If you have ticked any of the boxes above please give details here:
Does your Child require medication, either long term or existing conditions or life saving drugs such as ventolin? (Please give details of the medication and dosage). Please inform us of any specialist procedure for administering medication. Note: I understand it is my responsibility to inform staff of any changes. *
Does your Child have any special dietary needs or preferences? *
Required
If Yes; Please give details below
Does your Child have any known allergies? (Including sticky plasters / creams etc.) *
If Yes: Please give details below
To reduce the spread of infectious disease / diarrhoea / Sickness and viruses, I will ensure that my Child has had 48 hours clear and is well enough to attend. *
Name , address and contact details of GP Surgery *
Ethnicity and Cultural background
The following section requires information classed as 'sensitive personal data' for which we need your consent to collect and process. We request this data as, in some cases we have a contractual obligation to do so with our local authority , but also as we have a legitimate interest to allow us to plan and meet your Child's needs.
How would you describe your Child's ethnicity/cultural background? *
What is the main religion for your family? *
Are there any festivals or special occasions celebrated in your culture that your child will be taking part in and that you would like us to see acknowledged and celebrated while s/he is in our setting? Include detail of festivals you would prefer your Child not to join in with.
What is/are the main languages spoken at home?   *
Does your Child have any Special Educational Needs or Disabilities? Please provide details below including any specialist support and contact details of any professionals involved. *
Permissions and consent
The following section contains information for which we need your consent. As required by data protection we have a duty to inform you that you can withdraw your consent for any of the permissions detailed below at any time. Should you wish to withdraw consent please discuss this with a member of staff in the first instance.

All our staff are paediatric first aid trained and will administer basic first aid if needed. Permission for the setting is to act in loco parentis;
If emergency treatment is required, either whilst your child is on the premises or on an outing, (for the duration of your child’s time with us) and the parents or legal guardians cannot be reached immediately, your signature in the space provided below empowers the settings management to exercise their own judgement in calling the doctor/dentist/999  or to transport the child to a hospital casualty department by ambulance. Please read and fill in the declaration below, cross out the statement/wording that does not apply, and sign and date this section.
I/We Parent(s) /Guardian(s) of my Child named *
Required
Please include any detail if no consent is indicated. Provide name and contact of person completing the consent above. *
Sun cream- During hot weather I understand that is it my responsibility to ensure that my Child has had the first application of sun cream before they attend and provide a sun hat/cap and cream for them to wear and apply throughout the day.  Tick all that apply. *
Required
Please tick all the statements that apply to show you consent to the following; *
Required
I consent to my child having their photograph taken to be used for publicity purposes. Please tick all that apply *
Required
Thankyou for completing this form.
You are welcome to request to see the information we hold on you and your child at anytime through you ‘right of access under the GDPR regulation 2018 . The information you give us is paramount to the admission of your son or daughter to access our services. However, it is your right as the ‘Data Provider’ to have a clear understanding of why we collect the data.

We only collect data that is of legal obligation or legitimate interest to your child having a place at Little Owl Childcare Limited.

We will use the information you have given us about your child to track their learning and development and keep them safe.

We will use information provided about yourself to contact you about your child, access funding and keep your child safe.

We will use data you provide about other people at times we are unable to cannot contact you. It is your responsibility to ensure third parties know we hold their details

All data you provide will be stored securely at your child’s nursery setting, in some circumstances it may be transported securely to our company Head office this is generally for funding administration purposes and invoicing.  

If you need any further information please see our General Data Protection policy displayed in our settings and on our website.
Alternatively, you can contact Sarah McCormick on 07980 733 926/info@littleowlchildcare.co.uk.

Name and date of the person who has completed the above Registration form. *
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