Burntisland Out of School Service

Registration form

Published July 2012

Registration form

All information supplied by Parents/Guardians will be treated as Private and Confidential by all Employees at BOSS. The information will be securely stored and supplied to Staff on a need to know basis. Parents/Guardians will have access to their child's record on request.

This document is a contract between the signatory and Burntisland Out of School Service.

If you wish to view any of the policies and practices which govern the safe running of our service please contact the BOSS Manager.

Child 1:

Name: / D.O.B:
Medical conditions: / Medication:
Allergies: / Other Information:
Additional Information:

Child 2:

Name: / D.O.B:
Medical conditions: / Medication:
Allergies: / Other Information:
Additional Information:

Child 3:

Name: / D.O.B:
Medical conditions: / Medication:
Allergies: / Other Information:
Additional Information:

Child 4:

Name: / D.O.B:
Medical conditions: / Medication:
Allergies: / Other Information:
Additional Information:

Family Doctor details:

Name: / Address:
Telephone:
Additional Information:

Primary contact:

Name: / Primary contact number:
Work / Home / Mobile
Address: / Work address:
Post code: / Home Telephone:
Email address: / Mobile Number:
Relationship to child: / Work Telephone:

Note: At least two alternate contacts must be provided who are able to respond in an emergency situation. Please ensure you include anyone who may collect your child(ren) from BOSS in your absence.

Alternate contact 1:

Name: / Home Telephone:
Relationship to child(ren): / Mobile Number:
Permission to collect your child(ren) from BOSS / Work Telephone:

Alternate contact 2:

Name: / Home Telephone:
Relationship to child(ren): / Mobile Number:
Permission to collect your child(ren) from BOSS / Work Telephone:

Alternate contact 3:

Name: / Home Telephone:
Relationship to child(ren): / Mobile Number:
Permission to collect your child(ren) from BOSS / Work Telephone:

Consent required:

We would like to ask for your consent for the following items:

Consent / Yes / No
I consent for my child(ren) to attend activities outside BOSS premises as part of the programme
I consent for my child(ren) to be videoed or photographed participating in BOSS activities and understand that these may be used by BOSS in future publicity, funding applications, funding reports or use by the local press
I consent to any emergency medical/dental treatment being carried out as necessary
I consent to BOSS staff assisting, if necessary, with the application of sun screen that I have provided for my child(ren) or usage of BOSS sun screen if none is provided
I consent for my child(ren) to participate in face painting
I consent for my child(ren) to participate in hair and makeup activities

Fees / Attendance:

Upon registration an administration fee of £15 is required. This is an annual fee and is payable in August of each year, irrespective of when you started using the service during the school year. Fees for term-time attendance and play schemes will be reviewed on an annual basis, updates will be applied at the start of each school year.

Details of fees, methods of payment and the due dates for fees are shown on the appropriate program booking form. Fees for the service must be paid monthly in advance and failure to pay these in time may result in the service being withdrawn. Places booked but unused for any reason will be charged at the full amount during term-time. During Summer and Term-time play schemes seven days notice is required to cancel days booked.

Full fees will still be payable when a child(ren) is off ill.

Late collection fees will apply to the Summer Play scheme, Out of School Service and Term-time Play scheme and are charged for every part or whole 15 minute period after 6pm. These are payable within seven days.

Allocated days may be changed or swapped with at least 48 hours notice and will be provided subject to availability.

Terms & Conditions:

I will notify BOSS if there are any changes in my circumstances, especially contact details.

I will notify BOSS of any medication requirements for my child(ren) and complete the required consent form.

I will notify BOSS if my child(ren) are to be collected by someone other than those adults detailed on this form.

If my child is involved in an accident whilst at BOSS I will sign the accident form upon collection.

Acceptance:

I have completed the information as accurately as I am able and understand the conditions detailed above for use of Burntisland Out of School Service and agree to abide by these.

Signed (Parent / Carer)

Date

For Office use only. Received by: ______Date: ______

Additional Notes:

1 | P a g e

BOSS at Toll Centre, East Toll Park, Kirkcaldy Road, Burntisland, Fife, KY3 9HA

Tel & Fax: 01592 872854 Mobile: 07980429040

Email: