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)


    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):


    Gaming devices

    Sun Protection



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


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


    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


    Emergency Action

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


    Signature (Please type your name):

    Date YYYY-MM-DD:

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