Wise Owls Club - Maidenhead

A - Information About You

Section One - Main Parent/Carer (where child lives)

Section Two - Second Parent/Carer

Address if different from child

Section Three - Emergency Contact

Please detail an emergency contact that we are able to ring who can pick up your child in the event that we are unable to get hold of you.

B - Information About Your Child

Section One - Child Information

Section Two - Things We May Need to Know

Our role is to ensure the children in our care are safe and happy and to do that it helps if we have as much family and background information as possible. So please use this space to tell us anything you think is necessary ie. adoption/fostering/parents no longer together/parents deceased.

ALL INFORMATION PROVIDED WILL REMAIN PRIVATE & CONFIDENTIAL

Section Three - Additional Information

Please inform us of any additional information we need to be aware of, ie. people who are not authorised to collect the child (please ring office with more details if required):

Section Four - Medical Information

Part 1 - Doctor Contact Information

DOES YOUR CHILD HAVE ANY MEDICAL CONDITIONS? (Please specify)

Section Five - Allergies and Special Dietry Requirements

DOES YOUR CHILD HAVE ANY ALLERGIES? (Please specify)

ACTION TO BE TAKEN?

DOES YOUR CHILD HAVE ANY DIETRY REQUIREMENTS? (due to religion, family preference, way of life, health status, etc - please specify)

C - General Information and Confirmations

Section One - Please Tell Us Where You Heard About Wise Owls?

Section Two - Please Read Carefully and Complete ALL Parts

I agree that photos/video recordings of my child can be taken for advertising purposes, ie: posters, wall displays, our website, social networking sites such as Facebook / Twitter, newspaper pieces:

I understand that emergency services may be contacted during the running of the Club if thought appropriate. I understand that the play care staff are authorised to sign any written forms of consent required by the hospital authorities if my child’s life is in danger. I understand that first aid treatment may be carried out on my child by a first aid trained member of staff:

I consent for my child to travel on your minibuses (and in the event of a problem with the minibus, with staff in their cars who are insured to carry children) and go off site when this is detailed on the timetable:

I have read the Wise Owls Terms and Conditions and Policies and Procedures and acknowledge that I am bound by these. These are subject to change, but you will be informed if they are. The most current version will be on the website.

I understand to the best of my knowledge that the information provided in this form is correct.