Little Common School Club Registration Form

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Please complete this form to register your childs' place at the after school club at Little Common School. Please note that if you have completed this form before that there have been changes made which are essential. We are looking at a similar way in future to renew your child.

Email *

Child's Name *

Contact Name *

Address *

Your Child's School Year *

Year 3

Year 4

Year 5

Year 6

Date of Birth *

YYYY

Parents Email Address *

Contact Phone Number *

Emergency Contact *

Emergency Contact Number *

Duty of Care

As part of our duty of care we would ask that you provide us with an relevant information regarding any injury problems or allergies which we need to know as part of your child's participation in our activities. If your child has an epipen please indicate which this is kept. If your child has NO conditions that we need to be aware of please TYPE in NONE in the box below.

Relevant Medical Information

Declaration

I have completed the medical details above and I consent that, in the event of any illness/accident, any necessary treatment can be administered to my child, which may include the use of anaesthetics. The club CANNOT administer medications.

IMPORTANT - Collecting Your Child *

My Child will be collected after the session. If this is NOT the named contact please let us know if advance for safeguarding reasons.

My Child has permission to walk home after the club has finished.

Required

Signed: (Please type name) *

I understand payments of sessions are payable in advance and that I am committing to a period of 1 term. *

Yes

Required

Privacy Notice

The information provided above is used to enable us to contact you in relationship to your child's participation in our activities. This may include contacting you regarding your child's progress, informing you of the opportunities within the school club as well as opportunities that are considered suitable for your child, or may be of interest within Table Tennis Rother's general activities. Information provided is kept confidental, however, this may be shared with medical professionals in an emergency.

Where your child participates in our wider activities this may require us to register your child with Table Tennis England. Where this occurs you will be advised and will be able to access the information held. Details of how to do this will be provided by Table Tennis England via email.

When your child ceases to attend one of our clubs we will keep your information for up to 3 months in case they wish to return. After this, unless you contact us, we will delete this information and any paper forms will be shredded. You can ask us to delete this information at an earlier stage by contacting us.

A copy of your responses will be emailed to the address you provided.

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