Before & After School Club Form

Please complete in as much detail as possible and use an extra sheet if necessary

If you need help completing this form please telephone: Rochdale Family Information Service on 01706 927824 or email

Name of Before School Club
Name of After School Club
Is your setting registered with Ofsted?
Is your setting registered under a school’s registration?
Ofsted URN
(if applicable)

Provision Details:

Setting Address
Telephone
Email
Mobile
Website

Contact:

Main Contact
Position
Telephone (if different from above)

Details about your before & after school club

Please tell us details of sports, activities, play areas, garden facilities, snacks/ meals provided. Please include information about your childcare experience, qualifications and DBS checks.

Age Ranges

What age children do you cater for? Example: 4 -14 years

Places Available

How many placesare available for each club? Example:Before School = 45 / After School = 60

Opening hours

What are your opening hours?

Example: Before School = 7.30am-9.00am / After School = 3.15pm-6.00pm

Out of School Club Costs

Childcare Costs are notpublicised on the Family Service Directory and are used only for statistical purposes. We need this information to report to the Annual Childcare Sufficiency Report.

BEFORE SCHOOL CLUB
Per hour / £
Per Session / £
Full week of Before school sessions / £
AFTER SCHOOL CLUB
Per hour / £
Per Session / £
Full week of After school sessions / £
FULL WEEK OF BEFORE & AFTER SCHOOL CLUB / £

Inclusion

Please tell us about any experience you have working with children with special educational needs and disabilities. Example: experience working with Autistic children and qualified in sign language.Is there Wheelchair access available?

Staff

Please provide details of your staff.

BEFORE SCHOOL CLUB

Employee Name / Date of Birth / Job role (e.g. Teaching Assistant / Manager

AFTER SCHOOL CLUB(if different)

Employee Name / Date of Birth / Job role (e.g. Teaching Assistant / Manager

Data Protection

If in your work as a group provider, you store personal details about other people on your computer or any digital format (including PDA’s and photos on a digital camera), you will need to notify the Information Commissioner’s Office (ICO) that you are a “data controller”, for data protection purposes.

The ICO is the UK’s independent public body set up to promote access to official information and protect personal information and enforces and oversees the Data Protection Act.

If you are in any doubt about whether you will need to register, you can call the ICO on 01625 545 740 or check their website

Are you registered with the ICO? YES NO (please circle)

Consent Form

Declaration:

I declare that the information I have supplied is true and correct. I consent to any information I have supplied being used at the discretion of Rochdale Borough Council for statistical and informative purposes.

Signature
Name
Date

Publicity:

Rochdale Family Information Service would like to help you in marketing your childcare provision by making your information available to the public and other local authorities in the following ways:

  • Telephone enquiries
  • Post/Email enquiries
  • Face to face enquiries
  • Internet – Information is made available through Local Authority websites, government websites and other licensed channels.

For example: Rochdale Family Service Directory

If you would prefer that we do not publicise your provision, please opt out by ticking the box below:

I Do Not want my provision publicised by Rochdale Family Information Service

Data Protection Act:

The information you provide will be held by Rochdale Family Information Service and supplied to the public and on the internet, only if you have given your consent. If you do not give consent to supply your information to the public, it will be held by Rochdale Family Information Service for local authority regulated mailings and statistical purposes only.

Please note that information available via the internet may be accessed by people in countries and territories outside the European Union (EU) which may operate different levels of data protection than apply in the United Kingdom.

You may withdraw or change your consent at any time in the future, by writing to us at the address below.

Email completed form to or post to:

Rochdale Family Information Service

Rochdale Borough Council

Floor 4, Number One Riverside

Smith Street

Rochdale

OL16 1XU