c/o Bathgate Partnership Centre

Lindsay House, South Bridge Street

BATHGATE, EH48 1TS

Charity Number SC012049

Telephone: 07593 165100

Email:

Cmmunity Playgrups

ENROLMENT FORM

Please complete using BLOCK CAPITALS. All information is held in strict confidence.

Please tick a box to indicate which Playgroup you are applying for:

ARMADALE BATHGATE CROFTHEAD
Tue-Fri (9.15-11. 30am) Mon-Fri (9.15-11. 30am) Mon-Fri (9.15-11. 30am)
Tel: 07592 816761 Mon & Wed (12.15-2.30pm) Tel: 01506 467650
Tel: 07778 415120

KIRKNEWTON WEST CALDER
Tue/Wed/Fri (9.15-11. 30am) Mon-Thu (9.15-11. 30am)
Tel:07593 165100 Tel: 07581 751863
Preferred Day:
Monday (AM) Tuesday Wednesday (AM) Thursday Friday

Monday (PM) Wednesday (PM)

We are always keen to accommodate parental requests. As such, for future planning purposes, if your first choice of day or time is not available in your chosen playgroup, can you please indicate below what your preferred option(s) would be?

Child’s Full Name: M/F: / Date of Birth:
Address: / Contact Number -
Home:
Mobile:
e-mail:
Post Code:
Name of Parent/Carer:
Other People Authorised to Collect Your Child/Emergency Contact:
Name: / Relationship to Child: / Address: / Telephone:
Mobile:
Name: / Relationship to Child: / Address: / Telephone:
Mobile:
Child’s First Language:
Name and Address of Family Doctor: / Name and Address of Health Visitor:
Telephone: / Telephone:
Please state if your child’s immunisation is up to date:
Yes No

Does your child have any medical conditions, allergies, dietary requirements or require any regular medication?
Yes No

Due to changes in the medication administration policies and Early Years Scotland regulations, we need to know in advance of any medical conditions your child may have in order that we can arrange for suitable training and insurance cover, this must be in place before your child can start at playgroup. If your child suffers from any medical condition, allergies or requires regular medication of any kind, please contact the playgroup Manager as soon as possible to confidentially discuss any requirements.
I do/do not* give my consent for first aid to be given if I cannot be contacted.
Signature: / Date:
I agree/do not agree* to my child being photographed at Playgroup for:

Profiles/Learner Journey’s Yes No

Facebook Yes No
Publicity/Advertising Yes No
Signature: / Date:
Stay & Play Rota
To comply with Care Inspectorate regulations each parent/carer (friend/family member) is required to complete regular Stay & Play days in order to maintain the legally required adult to child ratio (1 adult: 5 children). On these days you will assist in the children’s play, clear snack and participate in other appropriate tasks.
Please sign below to confirm you understand the legal requirement to participate in our Stay & Play rota.

Signature: / Date:

Can you please inform us of any skills or access to resources through family/friends/work, which you would be willing to provide to benefit the children’s playgroup experiences?

Please tell us how you heard about Community Playgroups:

DATA PROTECTION ACT 1998

Community Playgroups hold all personal data collected in accordance with the rules laid down in the Data Protection Act 1998.

The Act requires that any personal data held should be:

(a)  processed fairly and lawfully;

(b)  obtained and processed only for specified and lawful purposes;

(c)  adequate, relevant and not excessive;

(d)  accurate and kept up to date;

(e)  held securely and for no longer than is necessary; and

(f)  not transferred to a country outside the European Economic Area unless there is an adequate level of data protection in that country.

SIGNATURE: / DATE:

For office use only

Date Place Offered
Accepted/Declined
Start Date