karen@clubland-playscheme.com
0208 979 3100
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Permission Form
Permission Form
Child's Name
*
First
Last
School
*
Claygate Primary Shool
Cranmere Primary School
Long Ditton Infant & Nursery School
Royal Kent Primary School
St Charles Borromeo
St James Primary School
St Martin's Primary School
St Paul’s RC
Thames Ditton Infant School
To comply with the Data Protection Act 1998 and Ofsted regulations we require your permission for the following:
My child to receive emergency treatment if necessary
*
Yes
No
My child to receive Infant Paracetamol and/or Piriton as and when deemed necessary
*
Yes
No
My child to go on local outings within walking distance
*
(to include visits to local parks & playgrounds)
Yes
No
My child to travel on a company vehicle, in accordance with Ofsted regulations
*
Yes
No
My child to travel in a member of staff's car, in compliance with Ofsted regulations
*
Yes
No
Sunscreen (provided by parent) to be applied as and when required by a member of staff
*
Yes
No
Child can watch appropriate 'PG' certificated films
*
Yes
No
I give permission for photographs or videos to be taken of my child (unidentified by their full name) to be diplayed...
At the club
*
Yes
No
In publications for Clubland
*
Yes
No
On the Clubland website
*
Yes
No
Media: Use of Names
*
Some Clubland activities attract elements of the media, do you consent to your child being photographed by local newspapers and other news media on the basis that their full names will be published along with their pictures?
Yes
No
Media: No use of Names
*
Do you give permission for your child's image to appear on newspaper websites or television images? These publishers will be asked to avoid using your child's name, unless you give permission for their name to be disclosed.
Yes
No
Images for Surrey Early Years Quality Assurance scheme:
*
I give permission for Clubland to use photographs to support our attainment of Surrey Early Years Quality Assurance Scheme and understand that Surrey Early Years moderators may view the photographs as part of the process.
Yes
No
I /we 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.
*
Yes
No
More information at: http://surreyscb.procedures.org.uk/pkppq/policy-and-strategic-framework/information-sharing
Parent/Carer's Consent
I have read and understood Clubland Playscheme Ltd's permission form. My decision on whether to give consent will remain valid for the duration of my child's involvement in the organisation, unless I notify them in writing.
Parent / Carer's Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Email
*
Date
*
Date Format: DD slash MM slash YYYY
Home
Locations
How To Apply
Holiday Club
Book Holiday Club
FAQ’s for Holiday club
Terms and Conditions
Parent’s Guide
FAQ
Payment
Policies & Procedures
Terms and Conditions
Contact Us