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St Margaret's Infant School
Orchard Street Rainham ME8 9AE
We are open from 7.30 am - 6.00 pm, Monday - Friday. We offer Childcare for children aged birth to 12 years. We aim to provide a happy, safe, and stimulating environment where our children can have fun.
1
Child Details
2
Parental Responsibility
3
Emergency Contacts
4
Medical Info
5
Other Details
6
Consents
7
Terms of Service
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Child’s first name:
*
Child’s surname:
*
D.O.B:
*
Child's gender:
*
Male
Female
Child's school:
Class:
Address:
Post code:
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Primary contact first name:
*
Surname:
*
Relationship:
Address:
*
Contact number:
*
Work number:
Email address:
*
Are there any other contact restrictions?:
Yes
No
Details:
Secondary contact first name:
Surname:
Relationship:
Address:
Contact number:
Work number:
Email address:
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Details must be different from previous section –‘Parental Responsibility’
Contact no.1 name:
Relationship:
Address:
Mobile number:
Work number:
Contact No.2 name:
Relationship:
Address:
Mobile number:
Work number:
I, hereby consent and grant permission to the following persons to collect my child (Must be 18 years or over):
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Doctor's name:
Surgery address:
Surgery phone Number:
Allergens severity:
*
NA
Very high
High
Medium
Low
Allergen's Name:
Medical condition(s) if any:
Does your child have any dietary requirements?:
Yes
No
Special needs:
Specific likes/dislikes:
Medication (Please list any medication your child takes regularly and the dosage):
Does your child have any special educational needs (SEN)?:
Yes
No
If your child has any learning difficulties/disabilities or requires additional assistance, please list them here:
Any other relevant information we may need to be aware of ?:
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Religion:
Christian
Muslim
Buddhist
Jewish
Sikh
Hindu
None
Prefer not to say
Others - please state
Other Religion:
Secret password:
First language:
Any other relevant information:
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Choose Consent Title
New Consent Title
Consent for using images & videos of child
Consent for medical advice or treatment
Consent for outings
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Consent for using images & videos of child:
From time to time we may take photographs of the children, we may use these images on our website or printed publicity. We may also make video or DVD recordings for use within the club or for monitoring purposes. Photographs or videos may also be taken by representatives from the media or local newspaper. To ensure we comply with the Data Protection Act 1998, we need your permission before we can photograph or make any recordings of your child:
I agree that my child can be photograhped or videoed for the sole purpose of sharing their activity and daily updates with me:
Yes
No
I agree that my child can be included in photos published on social media:
Yes
No
I agree that my child can be videoed for social media sites:
Yes
No
Consent for medical advice or treatment:
I give consent to seek any necessary medical advice or treatment in the future:
Yes
No
I give permission to apply plasters if needed:
Yes
No
I agree that my child can be given first aid if required:
Yes
No
I authorise the centre to allow the emergency contacts to pick up my child if I/the named guardians cannot be reached:
Yes
No
Consent for outings:
I give permission for my child to take part in local outings. for example, trip to local museum or local park:
Yes
No
I give permission to apply sun cream as necessary. Where required, I will provide sun hat, wellies or boots during hot/wet weather conditions:
Yes
No
Bicycling Consent - I permit my child to ride his/ her bike to school. I will ensure that my child uses a helmet and that his/ her bike is equipped with a light:
Yes
No
I agree that my child can watch a PG film:
Yes
No
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Please read our Terms & Conditions
View T&C's
Declaration
I accept the terms and conditions of [Centre Name]
Yes
No
Full Name of Parent/Carer:
Digital Signature
Date & time:
07, Jun 2021 01:12 pm
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