Krazy Kids Child Information Form

Child's Full Name* Name used (if different from above) Date of Birth* Home Address* Postcode* Email Address of person completing form*

Parent / Carer Details

Full Name* Relationship* Address (if different from above) Postcode (if different from above) Home Telephone Number Mobile Number* Email Address* Place of Work Work Telephone Number Work Mobile Number Work Email Address

Parent / Carer Details

Full Name Relationship Address (if different from above) Postcode (if different from above) Home Telephone Number (if different from above) Mobile Number Email Address Place of Work Work Telephone Number Work Mobile Number Work Email Address

Alternative Emergency Contact

Full Name Relationship Home Telephone Number Mobile Number Email Address

Authorised Person / Persons

Please give the names of any persons who you have authorised to collect your child from Krazy Kids Club. Please be aware that they must be 18 years or above and ID will be required.

Full Name Full Name Full Name Password

Health Information

Child's Doctor* Surgery Telephone Number* Surgery Address* Postcode* Please indicate whether there are any health issues which we should be aware of e.g. Asthma, Epilepsy, Hay Fever If your child is on any medication, please give details

If your child is on any medication, we will require an additional form to be completed and will discuss this with you directly.

Additional Information

Child's Main Language* Child's Religion Please indicate any cultural or religious observances that should be considered when caring for your child e.g. diet, dress, religious holidays Please indicate any behavioural issues, learning difficulties or sensitivities which we need to be aware of and taken into consideration Any other comments e.g. does your child have any particular interests of hobbies which we could encourage and support within the club?

Bure Park Primary

Krazy Kids Child Information Form

Parent / Carer Details

Parent / Carer Details

Alternative Emergency Contact

Authorised Person / Persons

Health Information

Additional Information

Bure Park Primary School