Goytre After School Club

Registered Charity No 1119483, CIW Registered

Including: The "Before School Club at GASC, The "All Day Club at GASC, and The "Holiday Club" at GASC
At Goytre Fawr Community Centre, School Lane, Penperlleni, Pontypool, Monmouthshire, NP4 0AH

This form is intended only for the parents of children who attend Goytre Fawr Primary School.

If this is not the case and you want your child to attend the "All Day Club" or the "Holiday Club" please contact the Club directly.

For all enquiries please email GASC on:

This web page is in two parts: The Child Details and a Health & Permissions section

Please complete both parts. Pressing TAB will take you to the next field. A physical signature is not required now, just tick the box. You will be asked to sign the form some time later.

THIS FORM IS UNDER DEVELOPMENT

Today is

Child Details
	Please read the notes below and complete the white boxes. One child per form. * Required fields
Parent's Name	Forename * Surname *
Child's Surname	* Enter your child's surname here
Child's Forename	* Enter your child's first forename here
Other Forenames	Any other forenames?
Name your child is known by
Date of Birth	* (dd/mm/yyyy)
Gender	Male Female *
Class	* Teacher If known
Which clubs will your child probably attend?	Before After All Day Holiday* At least one club must be chosen.
Does the child have any medical conditions that the club should be made aware of?	NO YES * If YES please give full details below, or on a separate sheet of paper. If you wish the Club to administer medicines you must give the Club explicit instructions and permission.
Child's Doctor
Surgery Address	*
Surgery Telephone Number	*
Ethnicity and Language	Care Inspectorate Wales require GASC to collect information on the ethnicity and language spoken by your child.
Ethnicity	*
Language	*
Signature	Tick this box to certify that the information on this form is correct * You will be asked to sign the form at a later date.
Storage of Information By signing this form you agree to the above details being stored on computer systems used by GASC. GASC trustees, management and administration are committed to maintaining the security of any personal data used and stored by the Club. The data will be used primarily for the business of the Club but the overriding ethos will be the protection of the children who attend the Club. The data will not be shared with anyone who is not directly concerned with the welfare of your child, except when legally required.
Health and Permissions
Emergency Consent
I consent to GASC administering any emergency treatment to the child named overleaf, during the running of the Club. I authorise the Club staff to sign any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child's health and safety. Please note that this consent will only be used in extreme circumstances, where we have tried and failed to contact you and if the doctor treating your child believes that your child's health is seriously threatened.
Do you give your consent? YES NO Signed (A physical signature will be required eventually) Date
Health

Example:	Condition:
	Treatment:
	Tick this box to give your consent to GASC giving the treatment specified
	You will be asked to sign the form at a later date.

Condition: Treatment: Tick this box to give your consent to GASC giving the treatment specified. * You will be asked to sign the form at a later date.
Dietary Requirements
Please tell us about any special dietary requirements that might have.
Photographic Permission
This is required so that GASC can take photographs of activities in which the children participate, the photographs will not be used for external publicity without your express permission. Do you give your consent for GASC to photograph your child? YES NO You will be asked to sign the form at a later date.
Visit Permission
GASC has been given permission to use Goytre Fawr Primary School's playing field on an occasional basis, it may also want to visit Goytre Park. GASC needs your permission to take your child to the school and the park. I give my permission for to visit and use Goytre park and Goytre Fawr Primary School's playing field and equipment. Yes No * You will be asked to sign the form at a later date.
Is there anything else you feel we ought to know about

Click this button to the form.	Click this button to the form.

Goytre After School Club

Child Details

Storage of Information

Health and Permissions

Emergency Consent

Health

Dietary Requirements

Photographic Permission

Visit Permission

Is there anything else you feel we ought to know about

Click this button to the form.

Click this button to the form.

Click this button to generate the . You will then need to send the encrypted Child Registration Details email to GASC.

Click this button to generate the .
You will then need to send the encrypted Child Registration Details email to GASC.