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Kineton After School Club (KASC) at Kineton C of E (Aided) Primary School Correspondence address: Kineton Playgroup Ltd Methodist Church Hall Southam Street Kineton CV35 0LL Telephone: 07772 432362 (24 hour answer phone) KASC Opening Hours 3.15 pm to 6.00 pm
Registration Contract
At KASC we are committed to offer a value for money After School service, where children are welcomed into our friendly, safe environment to take part in a variety of appropriate activities designed to maintain their independence and enhance their learning.
Contact Details
Child’s Full Name:
Name to be used at the Club:
Gender:				Date of Birth
Ethnicity:				Religion (if any):
Languages Spoken:
Names of Parents/Carers:
Home Address:
Home Telephone Number:				Mobile Telephone Number:
Parents/Carers Place of Work:
Parents/Carers Daytime Telephone Number:
Other Emergency Contact Details:
Persons Authorised to collect your child (please include contact numbers)
Name:				Contact Number:
Name:				Contact Number:
Medical Information
Doctor’s Name:				Telephone Number:
Doctor’s Address
Details of any significant health issues, allergies and other relevant medical information (including any Special Education Needs Statement and/or Physical Disabilities Statement:
Out of School Club Hours and Fees
A one off £10 Registration fee is payable which should be returned with this Contract. Please indicate in the boxes below which days and hours your child will attend KASC
Hours & Fees		Mon	Tues		Wed	Thurs		Fri
3.15 – 5.00 pm (£6.00)
3.15 – 6.00 pm (£9.00)
§ During these sessions drinks and snacks will be provided § Places will be allocated strictly on a first come first served basis and thereafter names will be entered on a waiting list. § Ad hoc sessions can be arranged if available – please ask the KASC Supervisor for details § Fees to be paid in advance either weekly, monthly or per half term in cash or by cheque (please make cheques payable to Kineton Playgroup Limited. Consistent late payment may jeopardise you child’s continued attendance at KASC.
Cancellation and Late Collection Penalties
§ Should you need to cancel any sessions booked please give sufficient notice. The following charges will apply: At least one week’s notice - no charge Less than one week (but at least 2 working days) - 50% fee payable No notice/no show - 100% fee payable § If a parent/carer is late collecting a child (i.e. after 6.00pm) a penalty of £10.00 for each 15 minutes or part of 15 minutes will be payable.
Consent Requests (please delete as appropriate)
I do/do not consent to KASC staff administering plasters to my child if required. Signed:
I do/do not consent for members of staff at KASC to apply sun cream to my child in hot conditions. Signed:
I do/do not consent for my child to use outdoor play equipment at KASC. Signed:
I do/do not consent to photographs of my child being taken and used in displays within the KASC setting? (Note: any photographs be used for internal purposes only and not passed to any third parties) Signed:
I herby consent for KASC staff to seek emergency medical attention should such action need to be taken. Signed
Any other relevant information:
I hereby consent for my child to take a place at KASC, according to the terms and conditions set out in its policies and procedure. I have understood the expectations and obligations relating to both myself and KASC and agree to abide by them. I herewith enclose my £10 Registration fee I understand that persistent late or non-payment of fees will jeopardise my child’s continued attendance at KASC. I confirm the above information I have given is correct and promise to notify the KASC Supervisor of any changes.
Signature of Parent/Carer:							Date:
	KASC is run by Kineton Playgroup Ltd registered in England and Wales (Registered No. 5812933) Registered Office: Methodist Church Hall, Southam Street, Kineton, Warwickshire, CV35 0LL
	Registered Charity (No. 1115513) DfES Number: 513611 URN 200651