Before & After School Booking Form

New Customer Registration Details

Thank you for booking a space on one of our Before & After School clubs. As this is your first booking with Dawn Til Dusk we just need a few more details to complete your booking.

Child's Name

First Last

Date of Birth*

Password for child collection*

Second Child's Name

First Last

Second Child's Date of Birth*

Password for second child's collection*

Third Child's Name

First Last

Events & Offers

We know that too many emails can be a nuisance and so we do not send out regular marketing. Sometimes, we have news or special offers which we think may be of interest. Let us know if you don't want to receive these emails.

I would like to receive information about future events
I DO NOT wish to receive information about future events

Third Child's Date of Birth*

Password for third child's collection*

More Information

Please add a new line if you are registering more than one child

First Language	M/F	Ethnicity	Religion	Name(s) Sibling(s) if attending

Parent/Guardian Details

Name

First Last

Is your child a looked after child?*

Yes
No

Do you have parental responsibility child?*

Yes
No

Do you have legal responsibility for the child?

Yes
No

Is your child in nappies?

Yes
No

Is your child currently under any early help provision (EHA) or Has your child had an Early Help Assessment completed for them?*

If the answer to this is Yes - please speak to your club Manager.

Yes
No

Is your child under any social care or district team support?*

If the answer to this is Yes - please speak to your club Manager.

Yes
No

Do you consent for the Club Manager to share information about your child with their class Teacher?*

Yes
No

Do you consent for the school to share information about your child with Dawn Until Dusk?*

Yes
No

Consent to hand over all records relating to your child to their education setting after they leave our club?*

Yes
No

Details of any other childcare provision (childminder/pre-school/nursery)

Details of any distinguishing marks (birth marks)

Child normally lives at this address

Home Address

Street Address City County Post Code

Work Address

Street Address City County Post Code

Contact Numbers

Email

Childcare Voucher Provider

Alternative Emergency Contact Details

Name	Telephone Number	Mobile Number	Address	Relationship to child

I give my authorisation for the following people to collect my child from Dawn Until Dusk

Please provide a maximum of three names

Details of child's doctor

Please indicate if your children DO NOT attend the same doctor

My children attend different doctors

Child's Name

First Last

Name of Doctor

Prefix Last

Address

Street Address City County Post Code

Phone

Medicine*

My child takes prescribed medicine
My child DOES NOT take prescribed medicine

Second Child's Name

First Last

Name of Second Child's Doctor

Prefix Last

Address

Street Address City County Post Code

Phone

Second Child's Medicine*

My child takes prescribed medicine
My child DOES NOT take prescribed medicine

Third Child's Name

First Last

Name of Third Child's Doctor

Prefix Last

Address

Street Address City County Post Code

Phone

Third Child's Medicine*

My child takes prescribed medicine
My child DOES NOT take prescribed medicine

About Your Child

Please detail any medical/additional/special needs your child has:

Please provide full details

Please detail any dietary requirements/ food allergies for your child:

Please provide full details

What are your child’s favourite activities?