Wrap around care contact form 2020-21

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete and submit this form before your child starts using our wrap around care facilities. Existing members should also complete the form to update our records.We will contact you electronically by ParentMail and you will be able to pay by debit/credit/paypal via ParentMail. We also accept childcare vouchers.

Email *

Name of child *

Date of birth *

In 2020-21 my child will be in *

Current address including postcode

Contact details- in order of priority for use in an emergency before/after school

Parent/carer 1(name, relationship to child and contact numbers)

Parent/carer 2

Parent/carer 3

Parent/carer 4

Medical, dietary and health details

Does your child suffer from

asthma

eczema

hayfever

Clear selection

Does your child have any allergies

Please list any dietary requirements

Please give details of any regular medication your child takes

Please give details of any medical /health conditions we should be aware of

Family GP name and contact number

Sessions required

I will be using the following payment method

My childcare voucher provider is

Consent *

I would like my child to be registered to use wrap around care

I understand breakfast club opens at 07.45am and that no unaccompanied children can be left on school premises before this time

I understand the costs are £5 per session, payable in advance

I understand the after school club running for SASM pupils closes at 6.00pm and that my child needs to be collected by one of the people named above.

I understand that the costs for after school club are £15 per session, payable in advance and that it is my responsibility to ensure my child is picked up by 6pm. An additional charge of £15 per 15 minuteswill be made for late pick ups and if the adults listed above cannot be contacted, the duty social worker will be called.

In an emergency, should any of the named contacts be unavailable, I agree to my child receiving medication, medical/surgical treatment as considered necessary by the medical authorities present

We often invite the local press to visit school events and like to include pictures of our children on our website and in newsletters. Photographs, videos and presentations are also displayed in school and on our website.

I confirm that I have read, understood and agree to comply with the conditions set out in the parent handbook

Required

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

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of St Andrew's and St Mark's CofE Junior School. Report Abuse

Forms