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SBK Sign up form
After school Breakfast and holiday club in Leith
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Email
*
Your email
Child's Full Name
*
Your answer
Date of birth
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Your answer
School
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Hermitage Park
Leith
Other:
Class
Your answer
What is your class start and finish time
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Your answer
Address
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Your answer
What date would you like your child to start with us
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MM
/
DD
/
YYYY
Service Required - Holiday club, Please let us know what dates.
Your answer
After School Club
Monday
Tuesday
Wednesday
Thursday
Parent/ guardian 1 - Name
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Your answer
Parent/ guardian 1 - Address
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Your answer
Parent/ guardian 1 - Phone number
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Your answer
Parent/ guardian 1 -Alternative phone number
Your answer
Parent/ guardian 1 - Email
*
Your answer
Parent/ guardian 2 - Name
Your answer
Parent/ guardian 2 - Address
Your answer
Parent/ guardian 2 - Telephone number
Your answer
Parent/ guardian 2 - Alternative telephone number
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Parent/ guardian 2 - Email
Your answer
Who can collect your Child 1 - Please write full name and telephone number
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Who can collect your Child 2 - Please write full name and telephone number
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Who can collect your Child 3 - Please write full name and telephone number
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Is there anyone who can not collect your child
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Emergency Contact - Name
*
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Emergency Contact - Address
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Emergency Contact - Phone number
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Your answer
Emergency Contact - Alternative number
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Emergency Contact - relationship to child
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Does your child have any dietary concerns
Yes
No
Clear selection
If yes please explain in further detail
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Does your child have any allergies
Yes
No
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If yes please explain in further details
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Does your child need any support or anything we need to be aware of prior to starting with us?
Yes
No
Please call me to discuss
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If yes please explain in further details
Your answer
Does your child have any Additional needs or special education concerns?
Yes
No
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If yes please explain in further details
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Does your child have any health conditions we need to be aware of?
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Other:
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If yes please explain in further details
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Does your child speak other languages
Yes
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Other:
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Are there any cultural issues you would like to make us aware of so we can best support your child.
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In the event of an emergency I give permission for the club to give emergency medical treatment or advice in my absence.
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Yes
No
Doctor - GP practice Name
*
Your answer
Doctor - Name
*
Your answer
Doctor - Address
*
Your answer
Doctor - Phone number
*
Your answer
Consent - I give consent to SBK staff to apply Sunscreen to my child
*
Yes
No
Consent - I give consent to SBK staff to apply first aid to my child
*
Yes
No
Consent - I give consent to children partaking in activities at SBK agree that video or photos may be used in marketing materials by SocialBall Kids. *
*
Yes
No
Consent -I give permission for my child to participate in excursions and spontaneous outings, without prior consent. (Such outings may include a walk to the park, visiting the local library etc).
*
Yes
No
Consent -I give permission for Social Ball Kids to contact me
*
Yes
No
Are there any interests or activities your child would like to do whilst they are with us
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