Registration Form | Sleep Out

Registration Pack

Please take a moment to fill out the form.

Child First Name

Guardian First Name

Guardian Email

Child Second Name

Guardian Last Name

Relationship

Collection Password

Guardian Phone

Are you a Nowca Member

Yes

Please list up to 2 contacts who Sleep Out can call In Case of an Emergency (ICE), if Sleep Out can't get hold of you.

ICE First Name

Relation to the Child

ICE Second Name

Contact Number

ICE First Name

Relation to the Child

ICE Second Name

Contact Number

Collection Statement

The Venue will allow collection by those individuals listed as ‘authorised to collect’ on the pre-registration document.

In addition to the above, any person listed below will be permitted to collect your child.

Any named person collecting your child will be asked to provide suitable ID upon arrival.

Any named person must provide the agreed Password stated below.

If the name, or password, does not match we will not release your child.

Should anyone not listed below try to collect your child we will contact you immediately and will not release your child.

If a child is not collected from the Venue, by the stated closing time, then the Manager will contact you to clarify the situation. In extreme circumstances, the only solution may be to contact the Local Authority.

Medical and Dietary Information

Medical Statement

If your child becomes unwell in our care we will, in the first instance, make every effort to contact you or failing that the emergency contact numbers as indicated on the pre-registration form.

If, however, no contacts are available and your child has a high temperature we would administer Paracetamol e.g. Calpol, or if suffering from allergy symptoms we would administer Chlorphenamine Maleate e.g. Piriton if you have consented below.

In life threatening circumstances a Doctor, or similar Medical Practitioner, will make decisions pertaining to the health of your child and Sleep Out is not responsible for any decisions taken.

It is your responsibility to make Sleep Out aware of any change pertaining to the health of your child.

Please write 'Yes' or 'No' to the following statments

Medical and Dietary Information

lease indicate below if there is any medical treatment(s) you do not wish your child to have in emergency situations:

Does your child have any birth marks or similar?

GP Name

GP Telephone number

GP Address

Safeguarding Statement

As a registered Ofsted child provider, we are required by law to follow the Child Protection Procedures agreed with the Local Safeguarding Children Board and Ofsted within our responsibility to ‘Safeguard Children’.

We will try to share with you any concerns we may have regarding injury or specific issues of concern at all times.
We will keep a record of such incidents and share this with you where applicable.
We do have a duty to refer to Social Services if we suspect your child is at risk of significant harm.
We will inform you if we make a referral to Social Services, unless to do so would place your child at increased risk of significant harm.
Our first concern will always be the welfare of your child.
We are obliged to share information with the Local Environmental Health Office and Ofsted as required. For further information please see our Safeguarding Policy

I understand and accept this Safeguarding Statement

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Your Signature

Date

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