Roby Rainbows Club Registration Form
2024 - 2025 - Please fill in 1 form per child
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Email *
Please read our full policy, including drop off and pick up procedures.
The full document can be found here Rainbows Policy
 *
Required
Name of child *
Child's Class *
Home address *
Date of birth *
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Name of parent(s)/carer(s) *
Contact telephone numbers *
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) *
Password for pick up for any other person picking child up who does not have parental responsibility (as above) *
Details of your child’s doctor - Name, Address & Phone Number *
Please list any medical problems, special educational needs or allergies your child may have *
Please record language spoken at home if English is an additional language
Please record any other information you wish the staff to know about your child
Please indicate, what your usual sessions would be -(choose as many as required) *
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. *
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 *
I give permission for photographs of my child to be used by Roby Rainbows. *
I give permission for sunscreen to be applied in the Summer when needed *
I give permission for members of staff from Roby Rainbows to apply face paints to my child *
I give permission for members of staff from Roby Rainbows to apply nail varnish to my child. *
I give permission for members of staff from Roby Rainbows to apply temporary tattoos to my child. *
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. *
Required
Signed *
Print Name *
date *
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This form was created inside of Roby Park Primary.

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