Gullane Community Children's Hub Application Form

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Gullane Community Children’s Hub is a Scottish Charitable Incorporated Organisation, SCIO (Charity number SC048602).

Please complete a separate form for each child.

Email *

Child's Name *

Child's Date of Birth *

Please make sure you fill in the day and month correctly as requested. The form often switches to the American format. And please ensure you fill in the correct year - it defaults to 2019!

YYYY

AFTER SCHOOL CLUB ONLY - Child's school, year group and class

e.g. Gullane/Dirleton Primary School, Primary 3, Class P3/4

Parent(s)'/Guardian(s)' Names *

Home Address and Postcode *

Phone Numbers *

Please include home and mobile numbers, including the name(s) of which parent/guardian's mobile number(s) you have included.

Main contact e-mail address

Additional E-mail addresses (please add any additional e-mail addresses you would like invoices and/or newsletters and emails to be sent to).

By providing an alternative email address you confirm that you have the consent of the owner of the email address to provide us with this information.

Emergency Contacts *

Please list below anyone (other than those listed above) who we can contact in case of an emergency. Please include their name, relationship and contact telephone number.

2. Additional Information

To enable us to ensure that a care plan is put in place for your child prior to them starting with us, please give details of any additional relevant information about your child or medical details (e.g specific dietary requirements, regular medication, allergies, asthma, changes in circumstances etc)

Does your child have any medical conditions or take any regular medications? *

Does your child have any special dietary requirements or allergies? *

Are you happy for your child to have a piece of birthday cake occasionally when celebrating a birthday? *

Yes

Please feel free to share with us any particular personal circumstances that may impact on your child's time at the Gullane Community Children's Hub. *

Please provide the names and relationships of ALL adults who have permission to collect your child. *

Please provide the names of any specific adults who DO NOT have permission to collect your child. *

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