Pencaitland 2025 / 2026 Out of School Club Registration Form

For the Parents and Carers of the Pencaitland Out of School Club.

GDPR Statement

Please note all information will be held in accordance within the General Data Protection Act. ELOSCN may have to share information from time to time, due to child protection or health issues, which we have a requirement to do. If information is required to be shared it will be done in accordance with ELOSCN's policies and procedures.

I have read and understand the above GDPR Statement and agree to my information being held and shared as per ELOSCN's policies and procedures

Registration

How many children are you registering?

You can register up to 3 children under the condition that they are all using the same service (dates and times), the contact and emergency details are the same and that they are all being paid for together.

Are you an existing ELOSCN customer?

ELOSCN Customer Reference Number

New customers will be advised of their unique customer reference number following completion of their initial registration using this form.

Your email address

Operating Times

Our club operates a Breakfast Club from Monday to Friday. The Breakfast Club is open from 07:30 to school bell. The After School Club is open from the school bell to 5:45 pm Monday - Thursday & school bell to 5:45pm on Friday.

Prices

Breakfast Club is £6.40 . After School Club is £14.50 Monday to Thursday & £19.80 on a Friday.

PLEASE NOTE THIS IS THE PRICE WHEN REGISTERING FOR A FULL YEAR. AD HOC PRICES ARE HIGHER THAN THIS AND ARE NOT GUARANTEED .

There is an annual registration fee (irrespective of the number of children registered) which is £35.00.

Service Requested

Please indicate the service that you need by selecting the appropriate boxes below.

Mon BC

Monday ASC

Tuesday BC

Tuesday ASC

Wednesday BC

Wednesday ASC

THIS SESSION IS NOW AT CAPACITY

Thursday BC

Thursday ASC

Fri BC

Friday ASC

Start Date

Regardless of your start date in August, you will be charged from Wednesday 13th August to qualify for the discounted rates shown above.

Child 1 - First Name

As stated on birth certificate.

Child 1 - Any other name that your child is known by

Child 1 - Last Name

Child 1 - Class

Please indicate the class that your child will be in when they return to school in August.

Child 1 - Gender

Child 1 - Date of Birth

Child 1 - Comments

Please provide any information that would be helpful to our staff relating to your first child.

Child 2

Child 2 - First Name

As stated on birth certificate.

Child 2 - Any other name that your child is known by

Child 2 - Last Name

Child 2 - Class

Child 2 - Gender

Child 2 - Date of Birth

Child 2 - Comments

Please provide any information that would be helpful to our staff relating to your second child.

Child 3

Child 3 - First Name

As stated on birth certificate.

Child 3 - Any other name that your child is known by

Child 3 - Last Name

Child 3 - Class

Child 3 - Gender

Child 3 - Date of Birth

Child 3 - Comments

Please provide any information that would be helpful to our staff relating to your third child.

Child(rens) Home Address

Child(rens) Home Address (Line 1)

Your Details

Your First Name

Your Last Name

Relationship to Child(ren)

Your Mobile Phone Number

Do you live at the address above

Please indicate whether you live at the same address as the children.

If you have answered No please state your address below.

Emergency Contact Information

We must have a minimum of 3 emergency contacts for your child(ren). If you have indicated above that your are contactable in an emergency, then please provide 2 more emergency contacts here. If you have indicated above that you are not contactable in an emergency, then please provide 3 emergency contacts here. THESE CONTACTS MUST BE WITHIN 20 MILES OF THE SETTING.

Other (1) Emergency Contact Full Name

Other (1) Emergency Contact Relationship to Child

Other (1) Emergency Contact Phone Number

Second Emergency Contact

Other (2) Emergency Contact Full Name

Other (2) Emergency Contact Relationship to Child

Other (2) Emergency Contact Phone Number

Third Emergency Contact

Other (3) Emergency Contact Full Name

Other (3) Emergency Contact Relationship to Child

Other (3) Emergency Address Contact (Phone Number)

Your Child(rens) Doctor's details

Doctor's Address

Doctor's Telephone Number (inc. area code)

Your Child(rens) Dentist's details

Dentist's Name

Dentist's Telephone Number (inc. area code)

Additional Support

In order to plan and provide appropriate care for each individual child it is important that staff have details of any additional support requirements. If you answer Yes to any of the additional support needs, please provide additional details in the box provided.

Does your child(ren) have any of the following

If yes please expand in this box

If more than one child is registered, please indicate which child and provide details of the support being provided.

Other additional Support or infomation?

Please provide details of any other additional support your child(ren) needs.

Medication

Please answer Yes or No to the following question. If you answer Yes, please provide details in the boxes below.

Does your child, or children, take medication on a regular basis?

if Yes, what medication does your child take?

If more than one child is registered, please indicate which child.

If Yes, what is the dosage and administration?

If more than one child is registered, please indicate which child.

If Yes, what are the symptoms of the illness?

If more than one child is registered, please indicate which child.

Does your child, or children, have special dietary needs?

If Yes, please advise which child the dietary need

If more than one child is registered, please indicate which child and provide details of the dietary need.

Consent

Photographic Consent

I consent to my child(ren) being photographed and those photographs being used for the promotion of Out of School Care and childcare in general.

Sun Cream

I give consent to the staff to dispense sun cream / spray to my child(ren) when necessary using a product provided by me or as deemed necessary with one held by the Club.

Outings

I give consent to the staff to take my child(ren) on outings during out of school hours.

Agreement

Parent / Carer Handbook Plus T&Cs

I have received, read and understood the Parent / Carer Handbook plus Terms and Conditions, as detailed, in order to use the ELOSCN Out of School Care Service.

Registration Fee

Card Type

Please select your form of payment to pay for the Registration Fee only.

Card Number

Please provide us with the long card number.

Card Expiration Month and Year (MM/YY)

Card Security Code (3 digits on the back of the card)

Card Holder - Name on Card

Your Monthly Payments for Childcare Fees

Within 10 working days of receiving your registration fee in our account, you will be emailed your payment confirmation form outlining your registration request and monthly payment terms via our Smart sheet App. Your registration will be pending until you have visited our club setting with your child(ren) to ensure the setting is suitable for both parties. Your club manager will then provide the office with confirmation of your child(s) space in which you will be included.

Intended Form of Payment

Childcare Voucher Company

Voucher / Government Tax Free Childcare reference number

Providing us with your Childcare Voucher Company Account number / Government Tax Free Childcare reference will greatly assist us in allocating your childcare voucher payments to your account. If you don't know the account number at the moment, please advise us as soon as possible following the completion of this form by e-mailing accounts@eloscn.com.

Monthly Payment Date

Please select which monthly payment date your Standing Order or Childcare Voucher payment will be set-up for which must be released on the 1st or 15th of each month.

Please provide any other important information regarding payment in the box below

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