Lakeview Preschool Booking and Registration Form Spaces at our Lakeview Preschool Are you an new customer?*If you are a new customer we will ask for a few extra details at the end of this booking form. For new registrations, we reserve the right to request a deposit before confirming any booking requests. Yes No Parent/Guardian's Name* First Last Email* Enter Email Confirm Email PhoneSetting*Please select your child's school from our list of settings below.Choose from the listLakeview PreschoolChild's Name* First Last More than one child to book in?Please select from the list below if you need to book more than one child for our Before & After School Club please phone us if you need to book more than 3 places with us I need to book 2 places I need to book 3 places Second Child's Name* First Last Third Child's Name* First Last Paying for your childcare*There are different options when paying for your childcare. Please let us know if your childcare will be: self funded, 2year old government funded, 15hours 3year old funded or 30hours 3year old funded. Please be advised that if you are wanting to use any form of government funding codes will need to be valid from the term before your start date and completed forms handed in to us. Any queries please contact us. Self Funded 2year old government funded 15hours 3year old government funded 30hours 3year old government funded Session TimesLakeview Preschool Session Times & Fees The fees are currently: Breakfast Club Session 7.30am – 9.00am = £5.25 Morning Session 9.00am - 12.00 = £14.75 Afternoon Session 12.00pm - 3.00pm = £14.75 After-School Session 3.00pm - 5.00pm = £10.25 After-School Session 3.00pm - 6.00pm = £14.75 Full Day Care 7.30am - 6.00pm individual days term time = £48.00 Full Day Care 7.30am - 6.00pm Monday to Friday term time = £42.00 For further booking information please call on 01234930505Session Times*Please tell us when you would like your sessions to start and your preferred days, sessions and pick up times ( for example Full Day session Monday and Tuesday, Morning Sessions Wednesday - Friday ) A member of staff will call you shortly to confirm availability For Office Use Only New Customer Registraion DetailsThank you for booking a space at our pre-school. 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*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Password for child collection*Second Child's Name First Last Second Child's Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Password for second child's collection*Third Child's Name First Last Third Child's Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Password for third child's collection*Events & OffersWe 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 More InformationPlease add a new line if you are registering more than one childFirst LanguageM/FEthnicityReligionName(s) Sibling(s) if attending Parent/Guardian DetailsName First Last Is your child a looked after child?*YesNoDo you have parental responsibility child?*YesNoDo you have legal responsibility for the child?YesNoIs your child in nappies?YesNo 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 ProviderAlternative Emergency Contact DetailsNameTelephone NumberMobile NumberAddressRelationship to child I give my authorisation for the following people to collect my child from Dawn Until DuskPlease provide a maximum of three names Details of child's doctorPlease indicate if your children DO NOT attend the same doctor My children attend different doctors Child's Name First Last Name of Doctor Mr.Mrs.MissMs.Dr.Prof. Prefix Last Address Street Address City County Post Code PhoneMedicine* My child takes prescribed medicine My child DOES NOT take prescribed medicine Second Child's Name First Last Name of Second Child's Doctor Mr.Mrs.MissMs.Dr.Prof. Prefix Last Address Street Address City County Post Code PhoneSecond 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 Mr.Mrs.MissMs.Dr.Prof. Prefix Last Address Street Address City County Post Code PhoneThird Child's Medicine* My child takes prescribed medicine My child DOES NOT take prescribed medicine About Your ChildPlease detail any medical/additional/special needs your child has:Please provide full detailsPlease detail any dietary requirements/ food allergies for your child:Please provide full detailsWhat are your child’s favourite activities? Parent/Carer's ContractChild's Name First Last Second Child's Name First Last Third Child's Name First Last Parent or Carer's Name First Last Conditions* I consent for my child to attend Dawn Until Dusk Ltd. I understand that the club has policies and procedures and that there are expectations and obligations relating to both the club and myself and my child and I agree to abide by them. I understand that Dawn Until Dusk Ltd is a play care facility and that whilst my child is there Dawn Until Dusk Ltd is legally responsible for him/her. My child will be provided with a snacks, meals and drinks whilst at the club unless otherwise requested. My child will be given stimulating and challenging play opportunities in a fun and safe environment. Once my child is delivered to Dawn Until Dusk Ltd he/she will be in the care of Dawn Until Dusk Ltd until collected and signed out by a ‘Named’ responsible adult. I understand that I will be charged the full cost of the booked session even if my child attends an afterschool club before coming to Dawn Until Dusk Ltd. Regular bookings will automatically be rolled over into the next academic year unless we are given notice to cancel them. The pre-school charges a one off (non-refundable) registration fee of £25 and an annual membership fee of £5 per child thereafter at the start of each academic year in September. I agree to pay my invoice by the 15th day of the invoiced month. This will include any sessions when my child does not attend a pre booked session unless the required notice has been given. I will inform the club manager/deputy if I am collecting my child from school on a day that he/she is booked in to the club. I understand a late payment fee of £25 will be added to my invoice if full payment is not received by the 15th of the month. A £2 fee will be applied to your account, at the manager’s discretion, if an absence is not communicated to us. I understand that payment by cheque will incur a £1 charge and payment by Paypal or debit/credit card will incur 3.4% plus 20p charge. It is my responsibility to keep the club manager informed of any alterations to the information regarding my child. I accept that whilst at Dawn Until Dusk Ltd my child may get involved in messy activities and will provide my child with appropriate clothing to accommodate this. Dawn Until Dusk Ltd closes at 6.00pm and if for any unforeseen circumstances I am going to be late, I will contact the manager/deputy. If my child is not collected by 6.00pm I will pay a charge of £20.00 per quarter of an hour to cover the costs of the two staff that are legally required to stay. If any child remains at 7.00pm, after doing everything possible to contact parents and emergency contacts, then Dawn Until Dusk Ltd will be legally required to contact Children's Social Care. Whilst we try to ensure the safety and security of items, we cannot be held responsible for anything lost or stolen. I have read the behaviour policy and agree to its terms and appreciate that in some circumstances it may be necessary to exclude my child from the club and I will pay for these missed sessions. Should there be any incidents at Out of School Club involving my child, I will be informed of the situation. If my child has an accident, then he/she will be treated by a qualified first aider and I will be informed of the situation as soon as possible. If there is a situation where my child needs urgent medical advice and treatment and I am unavailable, a member of staff from Out of School Club may sign any consent forms necessary for advice and treatment on my behalf. Any information and details regarding my child will be treated as confidential. However, there may be times, for example in cases of child protection concerns, when details of my child may be passed on to other agencies. For example Police, Children’s Social Care and Health Care Professionals. Where the club has endorsed my claim for Tax Credit, Out of School Club is legally obliged to notify the HMRC if I cease to use the service during the period of my claim unless I give a minimum of 10 days’ notice. Your Tax Credit claim form will indicate that we may be held jointly liable for any claim HMRC consider to be fraudulent. I agree to give 48 hours’ written notice (text/email/letter) for cancelling an Occasional / One-Off (Ad hoc) booking and 4 weeks’ notice for cancelling / altering a Permanent / Regular booking. If a set booking pattern is in place has been made until further notice or until a pre-specified end date, this is deemed to be a Permanent / Regular booking. We reserve the right to request a deposit before accepting any bookings. I have read and understood the above terms and conditions and I agree to abide by them. I agree to the Terms of Service Activity PermissionAt Dawn Until Dusk Ltd we give children a range of activities to take part in. Children's possessions that are brought into the club are done so at your own risk. We hold no responsibility for broken or lost possessions.PermissionsIn the table below we have listed the activities we feel we need parental permission for all activities are supervised by qualified members of staff; Please select items you DO NOT wish your child to take part in. Apply Suncream For children in nappies - Permission to apply sudocrem Observe for development, planning & activities Seek Medical Advice & Treatment Face painting Apply nail varnish Wash out spray colour/glitter for hair Temporary Tattoos Watch DVDs/Media for Parental Guidance (PG) Bouncy Castle Bonfire Night –Supervised sparkler activity Local outings out of the club Local walks around the club Childrens Plasters – In the event of a graze to the knee or elbow Supervised BBQ cooking fruit and marshmallow skewers If you would like your child to wear a helmet whilst using the scooters and bikes please provide the club with a named helmet TechnologySuch as: Sony XBOX Nintendo Wii Sony PSP DS/DSI. Dawn Until Dusk will not use games above the rating of age 7 Please select items you DO NOT wish your child to take part in. Permission to use childrens technology Permission to use games age 3-7 Outdoor PlaySuch as supervised painting puddles, supervised sledging in snow, supervised water activities in hot weather Please select items you DO NOT wish your child to take part in. Play outside in all weather conditions Digital MediaPhotographs to be published for the following purposes Please select items you DO NOT wish your child to take part in. Electronic and printed information at the club Displays and exhibitions at the club Website for the club Observation and Assesment Club records for my child Local newspaper National newspaper Other organisations website/promotional material At other childrens birthday parties Other Permission to Administer MedicineChild's Name First Last Confirm Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Address Street Address City County Post Code Doctor's Name Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix Last Address Street Address City County Post Code Permission* I give permission for medicine to be given to my child in accordance with the details above. Second Child's Name First Last Confirm Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Second Child's Address Street Address City County Post Code Second Child's Doctor's Name Mr.Mrs.MissMs.Dr.Prof. Prefix Last Address Street Address City County Post Code Permission* I give permission for medicine to be given to my child in accordance with the details above. Third Child's Name First Last Confirm Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Third Child's Address Street Address City County Post Code Third Child's Doctor's Name Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix Last Third Child's Doctor's Name First Last Address Street Address City County Post Code Address Street Address City County Post Code Permission* I give permission for medicine to be given to my child in accordance with the details above. Staff at Dawn Until Dusk Ltd. will only be permitted to administer medication to your child if you complete and return this form.Under no circumstances will members of staff administer medication against the will of a child.If you have any concerns/queries, please contact the Club Manager Terms of Service* Terms & Conditions Fees are payable on the 15th of the invoiced month and can be paid by cheque (£1 charge), electronic bank transfer, cash, Paypal (3.4% charge plus 20p), debit/credit card (3.4% charge plus 20p)or childcare vouchers There is a charge of £20 for collections after 6pm, a further £20 is payable for every 15 minutes thereafter, which will be added to the next invoice We reserve the right to pass unpaid accounts on to our debt collectors. The pre-school charges a one off (non-refundable) registration fee of £25 and an annual membership fee of £5 per child thereafter at the start of each academic year in September. Fees are charged for booked sessions whether the child attends or not, a £2 fee will be passed at the manager’s discretion if an absence is not communicated to us We offer a discount for siblings who are booked in with us Lakeview Pre-School. The first sibling would receive a 5% discount, the second sibling would receive a 10% discount and a third sibling would receive a 15% discount. Any subsequent siblings would receive the maximum discount of 15% each Parents may be eligible to claim the working tax credits call HM Revenue & Customs helpline: 0845 3003900 or visit www.hmrc.gov.uk/taxcredits 4 weeks’ written notice (text/email/letter) must be given to terminate your contract or to alter/cancel a permanent/regular booking 48 hours’ written notice (text/email/letter) must be given to cancel ad hoc (occasional / one-off) bookings Dawn Until Dusk Limited ensures any personal data collected will be retained securely for as long as necessary and only used for legitimate childcare related activities to facilitate the delivery of childcare services, or for the purpose of preventing and/or detecting fraud and/or crime, in accordance with the General Data Protection Regulation (GDPR) 2018. Dawn Until Dusk Limited's Data Protection Policy is available from the website at www.kidsdawntildusk.co.uk. I agree to the Terms of Service CAPTCHA
