Registration Form

By completing the registration form we will register your child. Information collected will be used for health and safety purposes.

First Name

Last Name

DOB

Gender

Ethnicity

School

School Year

1. Parent/Guardian Details

Title

1. First Name

1. Last Name

1. House Number and Street Name

1. Town/City

1. Postcode

1. Relationship To The Child

1. Email Address (we will use this email address to communicate with you)

1. Mobile Number

1. Home Telephone Number

1. Work Number

1. Does The Child Normally Live At This Address?

1. Does This Person Have Parental Responsibility For This Child

2. Parent/Guardian details:

2. Title

2. First Name

2. Last Name

2. House Number and Street Name

2. Town/City

2. Postcode

2. Relationship To The Child

2. Email

2. Mobile Number

2. Home Number

2. Work Number

2. Does The Child Normally Live At This Address?

2. Does This Person Have Parental Responsibility For This Child

Emergency Contact Details

3. Title

3. First Name

3. Last Name

3. House Number and Street Name

3. Town/City

3. Postcode

3. Relationship To The child

3. Telephone Number 1

3. Telephone Number 2

3. Does This Person Have Parental Responsibility For This child

Child's Doctor

Name of Doctor

Doctor's Address

Doctor's Telephone Number

About your child

Does Your Child Have Any Health Issues or Learning Difficulties?

Medical and/or Learning Difficulty Description

Regular Medications

Consent

By completing and sending this registration form you agree to your child to go home on their own at the end of their session. It is your responsibility to ensure your child arrives to the centre and equally has the support in place to be collected. You are responsible for the child before they enter Grade Up and after leaving the setting. I authorise the staff members at Grade Up to consent to any medical treatment necessary to ensure the health and safety of my child on my behalf.

Registration Form

Registration Form

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