Parental Permission

New to Rebecca’s? To secure a place, we need you to complete a Parental Permission Form

Out Of School Club Parental Permission

To secure a place at Rebecca’s Out of School Club, please complete the secure online form below or, download, complete and return a MS Word or PDF file Parental Permission form.

Please read through this sheet carefully. Ticking the boxes and submitting this secure online form is providing us with your consent for your child to attend Rebecca’s Out Of School Club and tells us that you have read and understood all of the terms by which your child will be child will be cared for.

Parent/carer's name (required)

Mr.Mrs.Ms.Miss.

Parent's email

Child's name (required)

Child's date of birth (required) (YYYY-MM-DD)

Which Out Of School Club do you wish for your child to attend?:

Please could you read and tick the following statements to give your permission for the following (if appropriate):

Allergies

Gaming devices

Sun Protection

Photographs

Publications/Website

I that my child's images can be included on the Website and facebook pages for Rebecca’s Scrap book.

Films

Occasionally we will watch U rated films. I that my child can watch these films.

Outings

Information Sharing

*Except in Child Protection cases where it is judged that the child may be placed further at risk.

First Aid

Administration of Medicine

Transportation

Emergency Action

*Please state if there are any exceptions to this i.e. blood transfusions and give details:

Signature

Signature (Please type your name):

Date YYYY-MM-DD:

Rebecca's Parental Permission
Rebecca's Child Info Form PDF
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