After School Club - Child Record Form

For club members who wish to complete their homework we offer a homework corner. Homework is voluntary and our setting is informal and relaxing. Other after school clubs that currently provide homework support have helped to improve attendance, higher achievement and greater motivation & self esteem.

Play offers children a physically engaging opportunity to learn the necessary life-skills they need to be successful in the classroom and later on in the workplace. Play also fosters a love of learning. Therefore, it is our aim to ensure that warm and welcoming play opportunities exist at Village End for every child.

—Child's Details————————————————--————

*Child's Name:
*Date of Birth:

—Parent's Details————————————————————

*Mother's Name:
*Mother's Email:
Mother's Work No:
Mother's Mobile No:
Father's Name:
Father's Email:
Father's Work No:
Father's Mobile No:
*Home Tel No:
*Home Address:
*Unique Password:

—School Details—————————————————————

*Child's School:
*Head Teacher:
*Form Teacher:
*School Tel No:

—Doctor's Details————————————————————

*Doctor's Name:
*Surgery Name:
*Tel No:

—Emergency Contact's Details————————-————

Example: Grandparents, Auntie/Uncle, Neighbour?
*Contact: (1)
*Home Tel No:
Mobile Tel No:
*Relationship to Child:
*Contact: (2)
*Home Tel No:
Mobile Tel No:
*Relationship to Child:

—Medical History————————————————————

Has your child been fully immunised against:

*Diphtheria
*Whooping Cough
*Tetanus
*Polio
*Measles
*Mumps
*Rubella
*Hib Meningitis
*Has your child had Chickenpox:

—Important Information————————————————

Does your child have any:

*Allergies:
*Special Diet:
*Health Problems:
*Childhood Illnesses:
*Medical Conditions:
Any other important information:
If the answer to any of the above was yes, please give details:
Please state religion if applicable:
Please disclose any other information about your child that may be useful for us to know:

—Submit Information——————————————-———

Village End - A place where children and young people can feel at home. A safe & secure environment full of activities to suit all age groups. A place where new members are made to feel welcome. Come along and meet the gang and see for yourself exactly what Village End has to offer.