Booking Form – PrepareRobo

School's Name:*

Child’s name:*

Parent/carer name:*

Contact address:*

Postcode:*

Child`s date of birth:*

Year group:*

Primary phone number:*

Secondary phone number:*

Email address:*

Person(s) authorised to collect the child other than the parent/carer above:

If your child attends another after school club/extended care/creche after our club or if they have a permission to walk home on their own please provide this information above. Children WILL NOT be dismissed to persons other than above specified. If you arrange for the child to be picked up by someone not on the list please notify us about this fact in advance.

Special medical conditions and other requirements (including medicines and taking instructions):

Any other information that we need to be aware of (emotional, behavioural, learning difficulties, additional nees etc.):

Emergency contact details (if different from above):

I confirm that the above information is correct to the best of my knowledge and I hereby give permission for my child to receive emergency medical treatment or First Aid in the event of staff being unable to contact me. *

Yes

I agree to my child being collected after the end of the After School Club on robotics at the by above specified persons.*

I agreeI do not agree

Do you give your consent for PrepareRobo Ltd to use for publicity and marketing purposes, without prior notification any photos or videos taken of the Participant during workshops and any statement (either written or oral) made by the participant or you? You may withdraw your consent for above at any time in a written form issued to PrepareRobo Ltd.*

YesNo

I have read, understand and accept Terms and Conditions and Privacy Policy.

First name*

Last name*

Date*

By submitting this form and the payment for the club you agree to our Terms and Conditions and Privacy Policy. Please note that your place will only be confirmed upon payment receipt.