Registration Form for Midstocket Out Of School Club

Child's first name: *

Child's surname: *

D.O.B: *

Age:

Student's gender: *

Male

Female

Prefer to self-describe

Is your child currently attending a school or nursery?:

Yes

Language(s) spoken at home:

Child’s Current School or Nursery: *

Proposed primary year, room number and teacher's name: *

Child's home address: *

12 Calsayseat Road
Aberdeen

Post code: *

Is English your child's first language?:

Proposed start date: *

If your child requires 1-2-1 or additional support please contact us before registering.: *

Primary contact first name: *

Surname: *

Relationship: *

Address: *

12 Calsayseat Road - AB25 3UY - Aberdeen

Contact number: *

Work number:

Email address: *

Are there any other contact restrictions?:

Yes

Details:

If calling my work select 'nurse clinic' option or leave a message with a colleague

Secondary contact first name:

Surname:

Relationship:

Address:

11C Back Hilton Road - AB25 3SS

Contact number:

Work number:

Email address:

Custody of the child is with:

Primary contact

Secondary contact

Both (joint custody)

Other

Contact no.1 name: *

Relationship: *

Address (If different from the primary contact): *

12 Calsayseat Road - AB25 3UY - Aberdeen

Mobile number: *

Work number:

Contact No.2 name:

Relationship:

Address (If different from the secondary contact):

11C Back Hilton Road - AB25 3SS

Mobile number:

Work number:

I, hereby consent and grant permission to the following persons to collect my child (Must be 18 years or over):

Ashley Finnie

Allergic reactions - Severity: *

Not Applicable

Very high

High

Medium

Low

Allergies, if any:

Medical conditions, if any:

Does your child have any dietary requirements?:

Yes

Special needs:

Does your child have any special educational needs (SEN)?:

Yes

If your child has any learning difficulties/disabilities or requires additional assistance, please list them here:

N/A

Any other relevant information we may need to be aware of ?:

None

GP name: *

GP address: *

GP phone number: *

Medication (please list any prescribed medication and dosage):

Religion:

Christian

Muslim

Buddhist

Jewish

Sikh

Hindu

None

Prefer not to say

Others - please state

Other Religion:

Secret password:

Days and sessions required: *

Please read our Terms & Conditions View T&C's

Any other instructions :

Early registration is recommended. Registrations will be considered in the order in which they are received. This form must be signed by the parent(s)/ guardian(s) with parental responsibility; applying for admission of the named child and who it is assumed will be responsible for the fees.

Declaration :

I accept the terms and conditions of the Midstocket Out of School Club

Yes No

Full Name of Parent/Carer:

Digital Signature

Raquel Ribeiro Halm

Date & time:

30, May 2024 03:58 pm

Midstocket Out of School Club

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