karen@clubland-playscheme.com
0208 979 3100

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Registration form

1 Registration

2 Permission

3 Sessions Requests

4 All about Me

5 Submit Registration

I am completing a:*
- New Registration
- Re Registration
For:*
- Permanent Sessions
- Ad hoc Sessions
- Holiday Club
Family Name:*
Family
School*
How many children do you need to register?*
- One
- Two
- Three
Child #1:
School*
Preferred Name:*
Preferred
Date of Birth:*
Date Format: DD slash MM slash YYYY
Gender:*
- Male
- Female
Reception Child:*
- Yes
- No
Class:*
Child #2
School*
Preferred Name:*
Preferred
Date of Birth:*
Date Format: DD slash MM slash YYYY
Gender:*
- Male
- Female
Reception Child:*
- Yes
- No
Class:*
Child #3
School*
Preferred Name:*
Preferred
Date of Birth:*
Date Format: DD slash MM slash YYYY
Gender:*
- Male
- Female
Reception Child:*
- Yes
- No
Class:*
Collection Password:*
This password is your authority to us to release your child to another person in the event that you are unable to collect
Home Address:*
Street Address Address Line 2 City / Town County Post Code
Name of Parent / Guardian:*
First Last
Relationship to Child:*
Daytime Tel:*
Evening Tel:*
Mobile Tel:*
Email*
Name of Parent / Guardian:
First Last
Relationship to Child:
Daytime Tel:
Evening Tel:
Mobile Tel:
Email
Name of Person/s who has Parental Responsibility:*
(All parents who can legally make decisions regarding this child. Click the + to add a person.)
Name of person who only has legal contact & not responsibility:
Are there any 'shared care' arrangements that may affect collection from Clubland:*
Alternative Emergency Contact:*
Someone other than the Parent/Guardian who can collect the child.
First Name Last Name
Daytime Tel:*
Mobile:*
Details of any Special Needs:*
Medical Conditions, Allergies and Medications:*
Dietary Needs:*
Doctors Name
Last Name
Doctors Tel:
Doctors Address:
Street Address Address Line 2 City / Town County Postal Code
Details of Cultural &/or Religious needs:*
Ethnicity: (Tick Applicable)*
- British
- Irish
- White & Black Caribbean
- White & Black African
- White & Asian
- Indian
- Pakistani
- Bangladeshi
- Caribbean
- African
- Chinese
Religion: (Tick Applicable)*
- C of E
- Catholic
- Other Christian
- Hindu
- Rastafarian Muslim
- Sikh
- Jewish
- Buddhist
Registration Information
All new applications whether ad hoc or permanent bookings will be processed upon receipt of a one- off, non-refundable registration fee of £10 per child to cover administration costs. Unless otherwise advised, Head office will call you to arrange payment.
If you are applying for Permanent sessions, a reservation fee is be payable to secure your child’s place.

The fee is calculated as follows:
- 1st child= £25
- 2nd child = £20
- 3rd child = £15
This reservation fee will be refunded in your 1st invoice provided you have not cancelled any sessions once they have been confirmed by us. For multiple child applications, the reservation fee will be reduced pro-rata if sessions are reduced per child.

However, if your booking is for the new academic year (September) you have until 14th August to cancel without forfeiting your reservation fee. Once school resumes in September, 6 weeks’ notice of cancellation of sessions is required, in writing (preferably by email).

Please note that if you are re-registering for September, we expect your child to return to Clubland when school resumes. If you delay their start date to coincide with the start of a sibling, we cannot guarantee their place.
Terms & Conditions:*
I confirm that I have read the Terms and Conditions of Clubland Playscheme Limited and agree to abide by them. Our full Policies & procedures are displayed at the Club house, or website: www.clubland-playscheme.com.

Please note there is a late fee payable for non- collection of children at closing time. Please see the website for details.
- I Agree

Save and Continue Later

To comply with the Data Protection Act 1998 and Ofsted regulations we require your permission for the following:
Child 1
Please tick the following boxes to show your permission for the following:
- My child to receive emergency treatment if necessary
- My child can watch appropriate 'PG' certificated films
- My child can go on local outings within walking distance (To include visits to local parks and playgrounds)
- My child can receive Infant Paracetamol and/or Piriton as and when deemed necessary
- My child can travel on a company vehicle, in accordance with Ofsted regulations
- My child can travel in a member of staff's car, in compliance with Ofsted regulations
I give permission for photographs to be taken of my child and that these photographs may be used for the following purposes:
In terms of GDPR I confirm that I am aware that my permission is not restricted to my child’s continued attendance at Clubland Playscheme Ltd and that I cannot withdraw my permission from a published photograph.
- To share information with existing and prospective families. (Display board, brochures, banners, photobooks and newsletters)
- To promote Clubland via newspapers without their names
- To promote or share news about the childcare setting (Clubland website & Facebook page) no names
- I give permission for my child to receive Sunscreen to be applied as and when required by a member of staff
- I agree to abide by the Surrey Multi-agency information Sharing Protocol (MAISP) which is the over-arching protocol in a two-tier framework for information sharing in Surrey. More information at: http://surreyscb.procedures.org.uk/pkppq/policy-and-strategic-framework/information-sharing
Child 2
Please tick the following boxes to show your permission for the following:
- My child to receive emergency treatment if necessary
- My child can watch appropriate 'PG' certificated films
- My child can go on local outings within walking distance (To include visits to local parks and playgrounds)
- My child can receive Infant Paracetamol and/or Piriton as and when deemed necessary
- My child can travel on a company vehicle, in accordance with Ofsted regulations
- My child can travel in a member of staff's car, in compliance with Ofsted regulations
I give permission for photographs to be taken of my child and that these photographs may be used for the following purposes:
In terms of GDPR I confirm that I am aware that my permission is not restricted to my child’s continued attendance at Clubland Playscheme Ltd and that I cannot withdraw my permission from a published photograph.
- To share information with existing and prospective families. (Display board, brochures, banners, photobooks and newsletters)
- To promote Clubland via newspapers without their names
- To promote or share news about the childcare setting (Clubland website & Facebook page) no names
- I give permission for my child to receive Sunscreen to be applied as and when required by a member of staff
- I agree to abide by the Surrey Multi-agency information Sharing Protocol (MAISP) which is the over-arching protocol in a two-tier framework for information sharing in Surrey. More information at: http://surreyscb.procedures.org.uk/pkppq/policy-and-strategic-framework/information-sharing
Child 3
Please tick the following boxes to show your permission for the following:
- My child to receive emergency treatment if necessary
- My child can watch appropriate 'PG' certificated films
- My child can go on local outings within walking distance (To include visits to local parks and playgrounds)
- My child can receive Infant Paracetamol and/or Piriton as and when deemed necessary
- My child can travel on a company vehicle, in accordance with Ofsted regulations
- My child can travel in a member of staff's car, in compliance with Ofsted regulations
I give permission for photographs to be taken of my child and that these photographs may be used for the following purposes:
In terms of GDPR I confirm that I am aware that my permission is not restricted to my child’s continued attendance at Clubland Playscheme Ltd and that I cannot withdraw my permission from a published photograph.
- To share information with existing and prospective families. (Display board, brochures, banners, photobooks and newsletters)
- To promote Clubland via newspapers without their names
- To promote or share news about the childcare setting (Clubland website & Facebook page) no names
- I give permission for my child to receive Sunscreen to be applied as and when required by a member of staff
- I agree to abide by the Surrey Multi-agency information Sharing Protocol (MAISP) which is the over-arching protocol in a two-tier framework for information sharing in Surrey. More information at: http://surreyscb.procedures.org.uk/pkppq/policy-and-strategic-framework/information-sharing
Parent/Carer's Consent
I confirm that I have read and understood the information provided on this form and that I give consent for photographs of my children/ren to be used as indicated by me. For the purposes of GDPR I confirm that I am aware that my permission is not restricted to my child’s attendance at Clubland Playscheme Ltd and that I cannot withdraw my permission from a published photograph.
Parent / Carer's Name*
Prefix First Last

Save and Continue Later

Breakfast Club Days Requested - Child 1
Start Date
Date Format: DD slash MM slash YYYY
Monday
Tuesday
Wednesday
Thursday
Friday
Breakfast Club Days Requested - Child 2
Start Date
Date Format: DD slash MM slash YYYY
Monday
Tuesday
Wednesday
Thursday
Friday
Breakfast Club Days Requested - Child 3
Start Date
Date Format: DD slash MM slash YYYY
Monday
Tuesday
Wednesday
Thursday
Friday
Afterschool Club Days Requested
Afterschool Days - Child 1
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Afterschool Days - Child 2
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Afterschool Days - Child 3
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Start Date
Date Format: DD slash MM slash YYYY
Session Terms & Conditions*
I agree to comply with the Terms and Condistions as published by Clubland. Should I wish to permamently cancel the sessions which my child attends at Clubland, I agree to give six weeks notice in writing or pay six week's fees in lieu. Fees remain payable for periods of absence (holidays and sickness) as the child's place is kept open and staff and accumulated costs continue to accumulate and have to be met by the Playscheme
- I Agree
Name of Parent / Guardian*
First Last
Email
Date
Date Format: DD slash MM slash YYYY

Save and Continue Later

About Me - Child 1
My Name is:
First Last
I am aged:*
Please enter a value between 3 and 18.
I attend:*
School Name*
I live with:*
We live in a:*
I get upset by:*
Things I like to do & places I like to go......*
I like to eat:*
I dislike eating:*
Things I want to do at Clubland:*
My home language(s) is/are...*
Please upload a photo*
Accepted file types: jpg, gif, png, jpeg.
About Me - Child 2
My Name is:
First Last
I am aged:*
Please enter a value between 3 and 18.
I attend:*
School Name*
I live with:*
We live in a:*
I get upset by:*
Things I like to do & places I like to go......*
I like to eat:*
I dislike eating:*
Things I want to do at Clubland:*
My home language(s) is/are...*
Please upload a photo*
Accepted file types: jpg, gif, png, jpeg.
About Me - Child 3
My Name is:
First Last
I am aged:*
Please enter a value between 3 and 18.
I attend:*
School name*
I live with:*
We live in a:*
I get upset by:*
Things I like to do & places I like to go......*
I like to eat:*
I dislike eating:*
Things I want to do at Clubland:*
My home language(s) is/are...*
Please upload a photo*
Accepted file types: jpg, gif, png, jpeg.

Save and Continue Later

Thank you for taking to the time to complete our registration process, please submit to commit your registration.
Thank you for providing your details for communication about your childcare. Clubland Playscheme Ltd would also like to keep you updated about our other childcare services that may suit your needs. We’ll only every communicate with you if you tell us you are happy to hear from us and only by the ways you select below. If you ever want to change the way we keep in tough, just let us know.
- Select All
- Email
- Post
- SMS
- Telephone
Email*
Please nominate an email address to be used for all invoices and communication purposes
Name
This field is for validation purposes and should be left unchanged.

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About Us

Clubland was established in 1996 with the aim of providing a safe, supervised and stimulating child centered environment. It has always been our intention to ensure that this provision is inclusive, reliable and an affordable childcare service.

Contact Information

Address: Clubland Playscheme Limited
Darven House
Armfield Close
West Molesey
Surrey
KT8 2RT
Phone: 0208 979 3100.
Email: karen@clubland-playscheme.com

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