Buzz Kidz Registration Form
Received by:
Actual start date:
Reg Fee Taken:
On system by:
All information provided will be handled in accordance to Buzz Kidz Confidentiality Procedures. Please complete in full.
Child’s details
Child’s full name as it appears on
birth certificate
Surname:
First Names:
Date of birth
Preferred name
Religion
Male /Female
Ethnicity
First Language
Date you wish your child to start (Please note this must be confirmed by Buzz Kidz before they start)
Proposed start date:
Collection password to be used if person collecting has not previously been seen by Buzz Kidz
Collection Password:
School Details (please notify us of any changes)
Name:
Class:
Year:
Child’s Home Address
Postcode:
Special Notes
Are there any court orders or injunctions restricting access? If yes please give details:
Please list all people who live in the child’s home, stating their relationship to child:
Is your child known to Social Services? If so, please give brief explanation. This information will only be used to
provide your family with the appropriate care:
Booking Details (this will be your set days and we will require four weeks notice to cancel)
Mon
Tues
Wed
St Mary’s Farnham Royal, Church Road, Slough, SL2 3AW: Breakfast
Club –
St Mary’s Farnham Royal, Our Lady of Peace, Priory & St Anthony’s
St Mary’s Farnham Royal, Church Road, Slough, SL2 3AW: After
School Club –
St Mary’s Farnham Royal, Our Lady of Peace, Priory & St Anthony’s
Western House, Richards Way, Slough, SL1 5JT:
After School Club –
Western house only
St Mary’s C of E, Yew Tree Road, Slough, SL1 2AR:
After School Club –
St Mary’s only
The Manor Youth Centre, Hanover Way, Windsor, SL4 5NW: After
School Club - Dedworth Green First and Middle, Homer First, Hilltop
First, Trevelyan.
Thur
Fri
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Contact Details (we will only release your child to those named below)
1st Contact full name as it appears on passport 2nd Contact full name as it appears on passport
Surname:
Surname:
First Names:
First Names:
Previous/ other names:
Date of birth:
Nationality:
Home address if different:
Previous/ other names:
Date of birth:
Nationality:
Home address if different:
Relationship to child:
Email:
Home Tel:
Mobile:
Profession:
Company Name:
Work Tel:
Relationship to child:
Email:
Home Tel:
Mobile:
Profession:
Company Name:
Work Tel:
3rd Contact full name as it appears on passport
4th Contact full name as it appears on passport
Surname:
First Names:
Previous/ other names:
Date of birth:
Nationality:
Home address if different:
Surname:
First Names:
Previous/ other names:
Date of birth:
Nationality:
Home address if different:
Relationship to child:
Email:
Home Tel:
Mobile:
Profession:
Company Name:
Work Tel:
Relationship to child:
Email:
Home Tel:
Mobile:
Profession:
Company Name:
Work Tel:
Bill Payer Details
All childcare costs should be paid in full by the 1st of each month
Name of person taking responsibility for payment:
Relationship to child:
Email address for invoicing:
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Medical Information
Doctor’s Name:
Name of surgery:
Address of surgery:
Tel no:
Has your child suffered from Asthma?
If yes, please give details:
Yes/No
Does your child have any allergies?
If yes, please specify:
Yes/No
Do they require any medication for this?
If yes, please specify:
Yes/No
Do they require any medication for this?
If yes, please specify:
Yes/No
Does your child have any other medical
conditions?
If yes, please specify:
Yes/No
Is your child on any other medication?
If yes, please specify:
Yes/No
Additional needs
The information you provide below will not affect your child’s offer of a place at Buzz Kidz. Failing to provide us with the correct
information will limit our skill base when providing care for your child.
Does your child have any physical/
sensory disabilities?
If yes, please specify:
Dietary Information
Halal
Vegetarian
Non Dairy
Nut Allergy
Parental Permission
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Does your child have, or is currently
awaiting a statement of special
education needs?
If so, please give full details:
Yes/No
Any other dietary requirement
If yes, please specify:
Yes/No
Please note that if you sign the below consents for your child, permission remains until you notify us otherwise in writing.
I give my consent to my child being transported on Buzz Kidz mini-buses:
I give my consent to my child receiving emergency treatment in my absence and I understand that by
doing this, Buzz Kidz will act as loco parentis until I arrive:
I give my consent for images/video of my child to be used within the setting. To comply with the Data
Protection Act 1998, we need your permission before we can photograph your child.
I give my consent for Buzz Kidz to liaise with other professionals involved in my child’s care:
I give my consent for my child to leave the premises for outings under the supervision of Buzz Kidz
staff:
I give my consent for my child to take part in messy play activities:
I give my consent for my child to be supported in the application of sun cream:
I give my consent for my child to be observed for staff training purposes:
I give my consent for my child to use computers provided by Buzz Kidz with the appropriate parental
restrictions:
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
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BUZZ KIDZ – TERMS AND CONDITIONS
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Children must be collected no later than 6.30pm from our Farnham Royal setting. All other settings finish at 6pm,
including our holiday club. Any late pickups may result in receiving a late charge which is £10 per 15 minutes or part
of.
If you wish to cancel your child’s place or change sessions you will need to give us one months’ notice in writing.
If your child is due to attend a session and for some reason cannot attend, you must inform a member of staff as
early as possible on one of the provided numbers.
Before your child attends, you must pay the registration fee and first month’s fees.
Parents must identify themselves to the supervisor before their child starts the club. Should arrangements be
made at anytime for any other adult to collect, the staff must be informed. Where possible, the person should be
introduced to staff beforehand. If this arrangement is made by telephone, the password from the registration
form will be requested to identify the person collecting the child. Children may only be collected by a suitable
adult. Please note we may ask to see photo identification.
When arriving with your child to each session, you must sign your child in on the register. We will not accept any
child into the setting unless their parent/authorised person accompanies them. On collecting your child, you must
present yourself to a member of staff and sign your child out before leaving the setting.
Unless it is requested as part of an activity, children should not bring any personal toys, games or valuable items to
the club.
Invoices will be sent out monthly by email. These must be paid for in full by the first day of each month. Failure to
pay your invoice may result in your child’s place being withdrawn.
There will be no refunds for booked sessions that children do not attend.
Behaviour by any person considered by the organisers to be unacceptable and inappropriate will not be tolerated.
These include smoking, alcohol, drug abuse, solvent abuse, bad or offensive language, bullying and any other
situation which could cause distress.
Continuous disruptive and unacceptable behaviour by any person (child or adult) will be reported to the
supervisor/manager.
Please respect our premises and all equipment at all times. Any child found to be misusing equipment or causing
damage to our premises, will be spoken to with a parent/carer present. Any damages caused by the children must
be reimbursed by their parent/carer. Failure to pay for any damage caused may result in the child being excluded
from the setting. The manager/supervisor reserves the right to exclude any person from the activity and or the
site, should such incidents occur.
Whilst attending the holiday club, children must wear suitable clothing/footwear (we encourage a change of clothes
for sport activities). During hot weather, children attending the setting should wear sun hats and sun lotion.
Buzz Kidz Ltd cannot be held responsible for any lost items or damage to personal belongings whilst attending the
setting.
All information exchanged between any persons involved with the setting must be kept strictly confidential.
Parents/carers must inform us of any changes to contact details, including new telephone numbers. Failure to keep
us informed of any changes may result in your child’s place being withdrawn.
Should any of the above Terms & Conditions not be adhered to, it may result in your child’s place being withdrawn.
These terms and conditions supersede any previous terms and conditions,
Please note Buzz Kidz will not take any responsibility for any payment made in error to any other organisation other
than Buzz Kidz.
Signed Parent/Carer
Print Name
Date
Please note by signing above it shows that you agree to the above terms and conditions and have entered into
a contract of childcare with Buzz Kidz Ltd which requires one month’s notice to cancel.
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