Sample Contract Between Provision and Parents/Carers and Registration Form

05 Sample contract and admission form

Sample contract between Treetops and parents/carers and admission form

The Scout Hall, Heol-Y-Delyn, Lisvane, Cardiff, CF14 0SR Tel: 07763 917724 Charity Number: 1027527 Contract and Admission Form

1 Child’s Full Name Sex: M/F Date of Birth

Address:05 Sample contract and admission form Position in Family: Language spoken at home: Ethnic Group: Postcode: Parent/Carer Name: Parent/Carer Name: Home tel: Home tel: Mobile: Mobile: Work tel: Work tel: Email: Email: Emergency Contact 1 Emergency Contact 2 Name: Name: Tel: Tel: Doctor’s Name: Adults allowed to collect the child (in Address: addition to the above) Name: Tel: Telephone Number: Name Tel: Health Visitor’s Name: Please note we will not release your child Telephone number: to anyone other than people mentioned on this form without prior authorisation

Agreed start date: Agreed sessions: Mon Tues Weds Thurs Fri Morning (9a.m to 11.30a.m) Afternoon (12.30p.m to 3p.m) Lunchclub

Fees: Please note our fees are currently £10.50 per session and £6 for lunch club. Fees are payable half-termly/termly in advance in cash, cheque (made payable to Treetops L.C.A Playgroup) or bank transfer (account number 80914010 sort code 20-18-17) and are due within 2 weeks of receipt of the bill. Late payment results in a penalty of £10 per week or part week that the payment is overdue. Refunds are not given for absences due to sickness, holidays or closure due to unforeseen circumstances (e.g. bad weather).

We require notice of half a term (6 weeks) if you wish to remove your child from Treetops or reduce the number of sessions your child attends.

Is your child up to date with all immunizations Yes/No If no please give details:

Does your child have any special dietary requirements Yes/No If yes please provide brief details and complete sheet in Treetops

2 Does your child have any special medical needs (e.g. Allergies) Yes/No If yes please provide brief details and complete sheet in Treetops 05 Sample contract and admission form

I would like a copy of this contract for my records Yes/No

Is there anything else you would like us to know about your child?

I will inform Treetops of any changes to the above information.

I confirm that I have read and understood Treetops Playgroup’s policy documents concerning Behaviour Management, Equal Opportunities, Health and Hygiene, Emergency procedures and Complaints. These can be found on the notice board inside Treetops or on our website treetopsplaygroup.co.uk Parent/carer signature

Date: Playleader signature

This contract and admission form was passed for use in Treetops

By: Position:

Date of planned review: