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Roby Rainbows Club Registration Form
2023 - 2024 - Please fill in 1 form per child
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* Indicates required question
Email
*
Your email
Please read our full policy, including drop off and pick up procedures.
The full document can be found here
Rainbows Policy
*
Yes, I have read the policy and understand the correct procedures and session times.
Required
Name of child
*
Your answer
Child's Class
*
Your answer
Home address
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Name of parent(s)/carer(s)
*
Your answer
Contact telephone numbers
*
Your answer
Emergency Contact, or any Person collecting the child from Roby Rainbows (different to above) Name, Address & Phone Number (add password on the next question, if you have added details here)
*
Your answer
Password for pick up for any other person picking child up who does not have parental responsibility (as above)
*
Your answer
Details of your child’s doctor - Name, Address & Phone Number
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Your answer
Please list any medical problems, special educational needs or allergies your child may have
*
Your answer
Please record language spoken at home if English is an additional language
Your answer
Please record any other information you wish the staff to know about your child
Your answer
Please indicate, what your usual sessions would be -(choose as many as required)
*
Monday Breakfast
Monday Afterschool
Tuesday Breakfast
Tuesday Afterschool
Wednesday Breakfast
Wednesday Afterschool
Thursday Breakfast
Thursday Afterschool
Friday Breakfast
Friday Afterschool
Required
I agree to pay school in accordance with requested days shown above and the information detailed within Roby Rainbows Club Policy. I understand that I am responsible for all payments during the academic year and that failure to pay may result in school seeking payment via a debt collection agent.
*
Yes
Required
I consent to any medical / emergency treatment necessary for my child during the running of Roby Rainbows. I authorise the Club Manager and/or Play Worker to sign any written form of consent required by hospital /authorities if the delay in obtaining my signature is deemed by a doctor to endanger my child’s health and safety. YES / NO
*
Yes
No
I give permission for photographs of my child to be used by Roby Rainbows.
*
Yes
No
I give permission for sunscreen to be applied in the Summer when needed
*
Yes
No
I give permission for members of staff from Roby Rainbows to apply face paints to my child
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Yes
No
I give permission for members of staff from Roby Rainbows to apply nail varnish to my child.
*
Yes
No
I give permission for members of staff from Roby Rainbows to apply temporary tattoos to my child.
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Yes
No
I understand that data collected is used for the purposes of Roby Rainbows as set out in this policy document and on the School’s Privacy Notice sent to parents/carers.
*
Yes
Required
Signed
*
Your answer
Print Name
*
Your answer
date
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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