Club Registration Form | Ducklings Pre-School

Child's First Name

Child's Surname

What s/he likes to be called:

Child's DOB

Day

Month

Year

School attended by child:

Child's First Language

Parent/Carer 1 First Name:

Parent/Carer 1 Surname

Home Address

Does the child usually live at this address?

Yes

No

Parent/Carer 1 Mobile number

Parent/Carer 1 Work number

Parent/Carer 1 Home number

Parent/Carer 1 Email

Does Parent/Carer 1 have parental responsibility for this child?

Yes

No

Parent/Carer 2 First Name:

Parent/Carer 2 Surname

Home Address (if different)

Does the child usually live at this address?

Yes

No

Parent/Carer 2 Mobile number

Parent/Carer 2 Work number

Parent/Carer 2 Home number

Parent/Carer 2 Email

Does Parent/Carer 2 have parental responsibility for this child?

Yes

No

Does anyone else have parental responsibility for this child?

Yes

No

If yes, please provide details below

Details of other person/s with parental responsibility

Include full name and contact details

Collection Password

Required to verify identity when collecting children

Full Name - Emergency Contact 1

Phone - Emergency Contact 1

Relationship to child - Emergency Contact 1

Full Name - Emergency Contact 2

Phone - Emergency Contact 2

Relationship to child - Emergency Contact 2

Child's Doctor

Doctor's Address

Doctor's Phone

Please include any additional/special needs your child has:

Please detail any dietary requirements/ food allergies:

Is there anything else we need to know about your child?

Fears, dislikes, favourite activities, etc

Sunscreen

I am happy for my child to use the sunscreen provided by the club

I will provide a bottle of sunscreen for my child to use at the club

Photograph Consent

Ducklings Website

Ducklings Facebook

Electronic and Printed Displays in the Club

Promotional materials and local/ national newspaper or magazine

Please tick for consent

Personal details or names of any child in a photograph will never be given in a such a way that would allow them to be individually identified (except when used in the child's own records).

I understand there will be no payment for my child's participation.

Consent will remain valid whilst your child is in the care of Ducklings Creaton.

Contract with Parents

I have read, understood and accept the terms and conditions

Signature of Parent/carer

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Date

Day

Month

Year

Ducklings Pre-School

Tel: 01604 505172
Mobile: 07881 808668
Email: creatonducklings18@gmail.com

18 Welford Road, Creaton, NN6 8NH

Club Registration Form for Primary After School Club and/or Holiday Club