test22 Monday, Jun 3, 2024 – Wednesday, Jul 3, 2030 12:15am – 12:30am Event Location Event Fees Fees £ 5.00( free places may be available via referral from your school ) REGISTER Child’s information Select Gender Male Female Current Year At School Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Ethnicity Indian Pakistani Bangladeshi Chinese Any other Asian background Caribbean African Any other Black, Black British, or Caribbean background White and Black Caribbean White and Black African White and Asian Any other Mixed or multiple ethnic background English, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Roma Any other White background Arab Any other ethnic group Free School Meal Does your child receive benefit related Free School Meals? If so you may be entitled to a FREE place at CHIPS Playscheme. The CHIPS Playscheme Administrator will be in contact to discuss this with you further. Does your child have any allergies? if yes please tick the box and provide information below Does your child have any Health Issues? if yes please tick the box and provide information below Does your child have any Dietary Requirements? if yes please tick the box and provide information below Does your child have any SEN/Additional Needs or 1-1 in school? if yes please tick the box and provide information below Lunch option FREE 2 course Lunch Healthy Packed Lunch (parent/carer to supply) Is there anything that would be helpful for us to know about your child to help them have a great time at CHIPS ? Parent/Carer Information Permissions Photo/Video Permission Consent for photos and/or video footage to be taken. Please be aware that we occasionally take photos and video footage of the children at CHIPS to share via our social media sites, to use as part of our fundraising process and for promotional reasons. Do you consent to your child having their photo taken/taking part in video footage for these reasons? Yes No Face Paint I give permission for a member of CHIPS staff to apply Face Paint to my child Yes No Sunscreen Protection I give permission for a member of CHIPS staff to apply sunscreen to my child as required Yes No Emergency Contact This is to be a person who can be contacted if we cannot contact parent/carer in case of an emergency Referral Has your school or social worker told you that you are eligible to book a free place at CHIPS (or are you a social worker booking a previously agreed free place)? GDPR I give my consent for CHIPS to contact me about future events and playschemes via email/post Yes No Doctor’s Details: Medical Aid I will notify the Playscheme Coordinator of any specific medication, which may need to be administered to my child, and will complete a Medication Consent Form . I give permission for my child to be administered first aid whilst at the CHIPS Playscheme I agree to the emergency medical treatment of my child by hospital staff if necessary Registration Fees You must select at least one item! Fees £ 5.00 0 1 2 3 4 5 6 7 8 9 10 11 12 Registration Fees Total
