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After the Bell - Child Registration Form

Complete the Child Registration form online here or download a copy 

After the Bell Child Registration Form

Child information & Service Requirements

Date of Birth
Day
Month
Year
Service Requirements (Place Type)
5 days
3 days
2 days
What days do you require?
Do you wish to take part in the NCS funding scheme?
Yes
No

Parent / Guardian Information

Please provide a mobile, a home phone number (where applicable) and work contact number (where applicable).

Please provide a mobile, a home phone number (where applicable) and work contact number (where applicable).

Who may be contacted in an emergency if parents are not available?

Please provide a mobile, home phone number (where applicable) and work contact number (where applicable).

Medical History & Care Plan

Note: Medical care plans may be required

Write NA if not applicable

Allergies

Does your child have any allergies?
Yes
No

If yes, please complete the following questions below

e.g. anaphylactic shock reaction, rash, reddening of skin, swelling, breathing issues etc.

e.g. epipen

If so, please provide details

Please outline any other information that is relevant

Prescribed Medication

Parents must sign and complete a medication form before prescribed medication is administered. Prescribed medication must clearly state child's name, dosage, route of administration, date and expiry date. We can only accept medicine that has the original pharmacy label and is written in the English language.


Agreement for Medical Treatment

I hereby give consent to my child (above named) receiving medical treatment if a doctor thinks it is required as an emergency and I cannot be contacted following reasonable attempts to do so prior to such treatment being administered.


In the event of an emergency an ambulance will be called. The parent will be contacted and informed about the emergency.

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Agreement for anti-febrile medication

The service will only administer ‘Calpol’ (paracetamol) or Nurofen (Ibuprofen) if a child becomes unwell and has high temperature of 38°C or over. If a child has a high temperature the parent will be contacted before staff administer the temperature reducing medication and they will be asked to collect the child.

My Child..
Does not have an allergy to anti-febrile medication
Has an allergy to anti-febrile medication and should not receive it.
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Immunisations

Note: We ask parents to provide a copy of all vaccinations the child has received

Please check all applicable immunisations that your child has received.
Copy of vaccination records provided?
Yes
NA / no
I confirm that my child has been vaccinated against all above checked diseases and viruses on the dates noted?
Yes
No / NA

Note: If your child is not vaccinated, we require you to sign a disclaimer form.

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Note: You may be required to complete a separate care plan in respect of your child relating to their additional needs.

Sun Policy

We ask parent(s) / Guardians to leave a ‘sunny day bag’ with sun hats, sun glasses etc. in our service. All children will be required to wear a hat when playing outside in the sun. The service will encourage all children to wear clothes that provide good sun protection e.g. sun hats, sunglasses. The service will also encourage children to cover very exposed areas of the skin, such as shoulders.


We ask parent(s) / Guardians to bring in a labeled bottle of unopened sun-cream of at least 40 SPF. Staff will apply the sun-cream to children before they go outdoors.


I give permission for sun-cream to be applied to my child from the labeled sun cream supplied. The sun cream will be applied in the correct way all over the body and in the correct amount. I will bring in an unopened and labeled bottle of sun-cream of at least 40 SPF.

I give permission for my child to..

Check / tick all that apply

While I / we do not give permission for our / my child to be photographed  I / we confirm that in the event of a class photo or group photo being taken within the Service or at an outing or event organised by the Service, for the purposes of inclusion of my / our child with his / her peers and / or members of staff that I / we consent to my / our child being photographed with his / her peers and / or staff members for such a class photo or group photograph only, on the strict condition that his / her face be redacted prior to any publication of the class or group photo either on Social media or in hard copy.

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Child Protection

We have a moral and legal obligation to ensure that all children in our care are protected, and their health and welfare are safeguarded. Our staff are mandated to report any concerns.

All staff in the service are vetted through the Garda vetting unit and have the correct qualifications to work with children. We act to protect children from harm, which may arise. It is our duty in this case to question the cause of any behaviour, bumps, bruises or unusual markings.


Our main concern in the service is to safeguard and protect the welfare of children. We have a responsibility to identify report and record any suspicions of child abuse to Tusla the Child and family Agency. We have a responsibility to respond to all child protection concerns.

Flight Risk
Yes my child is a flight risk
No my child is not a flight risk

To enable us to carry out any necessary risk assessments, please disclose whether you are aware if your child could potentially pose a ‘flight risk’ (i.e. a tendency to dart / run or seek opportunities to exit) while in the care of our service.

Collection Authorisation

I authorise the following people to collect my child in the event of my absence. I acknowledge unless I have spoken to the Manager my child cannot be collected by any other person.

Please also provide relationship to child

Please also provide relationship to child

Please also provide relationship to child

Separated & Divorced Parents

Married parents are automatically joint guardians of their children. Neither separation nor divorce changes this.


By law, an unmarried mother is the automatic guardian of a child born outside of marriage. In some circumstances, unmarried fathers have automatic access. The service should be informed about access rights. Unmarried fathers will automatically become guardians of their children if they meet a cohabitation requirement. An unmarried father who cohabits for 12 months with the child's mother, including 3 months following a child's birth, will automatically become the child's guardian. This provision is not retrospective, so guardianship will only be acquired automatically where the parents live together for at least 12 months (applies to children born after 18 January 2016.)


● We cannot refuse either parent to collect their child unless a court order is in place.

● We ask that parents give us information on any person that does not have legal access to the child.

● Where custody of a child is granted to one parent, we would ask you to clarify the circumstances with us.


This information will remain confidential and will only be made known to the relevant staff. If there is any legal documents i.e. custody order, barring order we would ask you to provide us with a copy to keep on file.

Data Privacy - Consent for Collection and Usage of your personal data

Please ensure that all parents or guardians whose information has been supplied in this form read and complete the following:

  • I have read the Service’s Privacy Notice, and I understand the reasons for requesting the personal information sought about myself and my child in this Registration form.

  • I consent to the collection and processing of the data given, for these purposes.

  • I understand that I can request a copy of this information, and revise or withdraw my consent by contacting the service at any time.

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I confirm and consent that I have read thoroughly, and responded accurately and truthfully, to all particulars contained within this registration form.

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I confirm and consent that I have read thoroughly, and responded accurately and truthfully, to all particulars contained within this registration form.

Little Dale Academy 

19/21 Dale Road

Stillorgan

Co. Dublin

A94 K8W7

 

+353 1 288 8836

Little Willows Academy 

24 Willow Road

Dublin 16

D16 KC86

+353 1 298 2498

© 2024

Room to Grow

1 Watson Road

Killiney

Co. Dublin

A96 TR90

+353 1 235 0921

After the Bell

28 Dale Road

Stillorgan

Co. Dublin

A94 W8Y6

 

+353 1 288 8836

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