Bridge & Patrixbourne Extended School Club Registration

Headteacher: James Tibbles Bridge & Patrixbourne C.E.P. School Conyngham Lane Tel: 01227 830276 Bridge, Canterbury Email: office@bridge.kent.sch.uk Kent Web: www.bridge.kent.sch.uk CT4 5JX

NAME OF CHILD ………………………………………………………………………….

D.O.B. ……………………………………………………….

CLASS …………………………………………………………

Please circle the provision required: - Breakfast Club After School Club Both

Please circle the days required every week:-

Breakfast Club: - Monday Tuesday Wednesday Thursday Friday

 Term Time only, 7:30am – 8:50am.  £4.00 per session.  Please arrive before 8:15am if your child/children require breakfast.  Please provide your child/children with a toothbrush and toothpaste in a named case, so that their teeth can be cleaned after food.

Afterschool Club: - Monday Tuesday Wednesday Thursday Friday

 Term Time only, 3:15pm – 6pm  £7.50 per session.  Snack is served between 4:30pm & 5:15pm  Collection of your child/children after 6pm will incur a flat rate charge of £10.00 per child, on top of the £7.50 session price.

Medical conditions/food allergies

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Wisdom ~ Trust ~ Forgiveness ~ Thankfulness ~ Friendship ~ Compassion Parent contact details: - ………………………………………………….. Emergency contact: 1 ………………………………………………

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Email : ………………………………………………………………………………………………………………………….

PASSWORD (please do not use their DOB) ………………………………………………………………….

This must be used on every collection. If you send someone else to collect your child/children, they will need to be told the password for collection.

Photographs (please circle all relevant)

I (print name)………………………………………………….give my consent to Bridge and Patrixbourne Church of England Primary School BASC staff to take photographs of my child(ren) using a school camera and use photographs for:

The school website Displays in the hall Leaflets/newsletters

Face painting

I (print name)…………………………………………………give my consent for my child(ren) to have their face/arm painted during face painting activities.

Administration of Medicine

Medicine administration forms need to be completed and signed by parent/carers wishing to have any drug administered to their child/children during breakfast and/or after school club. This will be administered by qualified staff and forms obtained from the office.

I (print name)………………………………………………….. Give my consent to Bridge and Patrixbourne Church of England Primary School BASC staff administering basic first aid.

Signature of parent/carer ………………………………………………………… Dated ……………………………………………………………..

I (print name) ……………………………………………………. Give my consent to Bridge and Patrixbourne Church of England Primary School BASC staff signing on my behalf, any written form or consent required by hospital authorities, including anaesthetic, if delay in getting my signature is considered by a medical practitioner in attendance to endanger my child’s health and safety.

Signature of parent/carer ………………………………………………………… Dated ……………………………………………………………..

I (print name) will contact the school BASC to report my child’s absence from their booked session. I am aware that I will still be charged to secure my child’s place.

I will give 1 weeks’ notice to cancel my child’s permanent place, so it can be offered to a family waiting.

Signature of parent/carer ………………………………………………………… Dated ……………………………………………………………..

BASC Mobile number: - 07895 932895

Email : - [email protected]

Wisdom ~ Trust ~ Forgiveness ~ Thankfulness ~ Friendship ~ Compassion