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Childs details

Child's full name:

Name to be used at School Wrap (if different):

Date of birth:

Gender:

School your child attends:

Nationality:

Language spoken

Religion (if any):

Family information

Name of parents/carers:

Home address:

Home telephone number:

Mobile numbers:

Email address:

Parents/carers’ place of work:

Parents/carers’ work number:

Doctor's name:

Address:

Telephone number:

Are all immunisations up to date? Yes / No (please record if not):

Details of any significant health issues (including a special educational needs and/or physical disabilities statement):

Details of any special dietary requirements, food intolerances, allergies:

Does your child have asthma?

Accidents and Emergency

In the event that my child is involved in a serious incident whilst at School Wrap, I expect the manager, or a delegated member of staff, to contact me immediately on the parental contact number provided.

In the event that my child requires medical treatment, I give permission for a trained first aider to administer first aid until a paramedic arrives.

If emergency treatment needs to be given to my child before I can get to the hospital, I hereby authorise the manager, or a delegated member of staff, to consent to emergency medical treatment on my behalf.

I understand that this authorisation will remain valid unless I contact the manager to withdraw it.

I parent/carer consent

I parent/carer agree to the Terms and Conditions

I parent/carer agree to the Code of Conduct

Name of parent/carer: (if any):