We aim to provide your child with the best possible care, meet their individual needs, and support them with their learning and development. Please can you assist in completing this Personal Care Plan so we can gather essential information about your child including emergency contact details, dietary information, medical requirements, abilities, routines, and favourite activities. We will ask you to review this information regularly to ensure it is up to date.

Any information provided will be treated as private and confidential. Please refer to the GDPR, Confidentiality, Privacy & DPA Policy for further details.

Child's Details

Child's Full Name *

Photo Upload *

Drop your file here or click here to upload You can upload up to 1 files.

Please upload a passport style photograph of your child so that staff can easily recognise them for pick up & drop off.

Date of Birth *

Home Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Parents / Carers Details

Mother's Details

Mother's Full Name *

Main Contact Number *

Home Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Email Address *

Alternate Contact Number

Father's Details

Father's Full Name *

Main Contact Number *

Address

Address Line 1

Address Line 2

Town / City

County

Post Code

Email Address *

Alternate Contact Number

Dou you wish to add another carer's details? *

Other Carer's Details

Carer's Full Name *

Main Contact Number *

Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Email *

Alternate Contact Number

EMERGENCY CONTACTS

In the event of an emergency, staff will always try to contact parents / guardians first. If for whatever reason we cannot contact you, please give the names and contact details of two other people we can call.

Emergency Contact 1 *

Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Contact Number *

Emergency Contact 1 *

I confirm that this emergency contact has consented to share their information

Emergency Contact 2 *

Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Contact Number *

Emergency Contact 2

I confirm that this emergency contact has consented to share their information

Childcare Arrangement

Week Commencing 13th July *

Monday (09:00 - 16:00)
Tuesday (09:00 - 16:00)
Wednesday (09:00 - 16:00)
Thursday (09:00 - 16:00)
Not Applicable

Week Commencing 20th July *

Monday (09:00 - 16:00)
Tuesday (09:00 - 16:00)
Wednesday (09:00 - 16:00)
Thursday (09:00 - 16:00)
Not Applicable

Week Commencing 27th July *

Monday (09:00 - 16:00)
Tuesday (09:00 - 16:00)
Wednesday (09:00 - 16:00)
Thursday (09:00 - 16:00)
Not Applicable

Child will usually be dropped off / collected by: *

Please enter the names and details of any other person(s) permitted to collect your child: (MUST BE OVER 16 YEARS OF AGE)

Responsible Person(s) *

Please confirm that consent has been given to share their information.

Password for collection if not collected by parent/guardian: *

Dietary Requirements

Does your child have any special dietary requirements, allergies, or food intolerances? *

Please give details: *

Medical Information

Doctor's Name *

Doctor's Address *

Address Line 1

Address Line 2

Town / City

County

Post Code

Doctor's Contact Number *

Is your child fully up to date with their immunisations / vaccinations? *

If no, please detail: *

Does your child have any health problems / allergies or food intolerances? *

If yes, please detail: *

Does your child have any additional support needs or disabilities? *

If yes, please detail: *

Please see the Equal Opportunities & Inclusion Policy for details of support offered within the service.

Is your child is receiving medical treatment, or do they require regular medication? *

If yes, please detail: *

Please see the Use, Storage & Administration of Medicine Policy for details about administration of medicine within service.

Other Information

Please provide any other information that my assist staff in respecting your families religious beliefs / cultural beliefs, and meeting care preferences

e.g. Main language, other languages spoken at home, religion or festivals celebrated at home

About Your Child

Likes, Dislikes & Favourite Things

This information is optional but will assist staff in meeting individual needs and care preferences, for example providing toys and activities that your child likes and is familiar with will help to capture their interest and give them a sense of belonging.

Food & Drink

Likes / Dislikes / Favourites

You must remember to include any allergies or intolerances in the dietary requirements section of this form.

Toys & Activities

Likes / Dislikes / Favourites

Books / Games / TV Programmes / Cartoon Characters

Likes / Dislikes / Favourites

Routines & Self-Care Skills

This information is optional but will assist staff in meeting individual needs, care preferences and help to ensure the comfort of your child.

Sometimes needs a bit of help to...

Go to the toilet
Wash their hands
Get dressed (Coats, zips, buttons etc)
Put shoes on / tie laces

Attends *

Class / Primary *

Further Information

This information is optional but will assist staff in meeting individual needs, care preferences and help to ensure the comfort of your child.

Please let us know any other information that you feel is important for staff to know and that will help us to provide the best possible care for your child.

For example, do they have any additional support needs, fears? Are they shy in large groups or around strangers, etc?

Permissions

Please tick each box below to confirm you have read and give your consent.

Accidents & Emergencies *

I give my permission for my child to receive basic first aid within the setting, where necessary. I understand that I will see a copy of any accident / incident reports involving my child, which I must sign and date.
I give permission for plasters to be used on my child, where necessary.
I give permission for my child to be taken to the accident and emergency department (A&E) for urgent medical attention if this is necessary and I cannot collect them immediately.
I agree to my child being left in the care of staff in case of an emergency. I agree to collect my child as soon as possible after being contacted, should this occur.
I give permission for my contact details to be shared with staff, for use only in case of an emergency.
I have checked with my emergency contacts, and they are also happy to have their contact details shared with staff as required.
I do not give consent to any of the above

Physical Contact *

I give permission for my child to have sun cream applied as required on hot days.
I give permission for wet wipes/hand sanitiser to be used on my child.
I do not give consent to any of the above

Off-Site Journeys *

I give permission for my child to go on outings to various locations for example, to the shops, woodland, playground etc.
I give permission for my child to be taken on car journeys in a vehicle belonging to Emma Taylor. I understand that they must have an up-to-date MOT, road tax and relevant insurance, as well as appropriate car seats for each child.
I give permission for my child to be taken on short journeys via public transport.
I do not give consent to any of the above

I give permission for my child to use large outdoor equipment in the setting and in purpose-built playgrounds. *

Photographs & Observations

I give permission for photographs to be taken of my child *

Acceptable Use *I agree that any photographs sent to me showing other children in the setting will be for personal use only by parents/carers. They will, under no circumstances, be shared on social media or sent to anybody else outside the setting.

If you do not give consent for photographs to be used in some of the situations below, please leave the relevant boxes blank to make your wishes clear. *

to be sent to me via email/private group message/direct message
to be shared in group messages, which can be seen by other parents from the setting.
to be seen in the background of photographs taken of other children and sent to their parents/carers.
to be used in a portfolio to be kept in the setting and viewed by children, prospective parents, childcare course evaluators, Care inspectorate, etc.
to be used freely on the services website/social media page, as an advertisement for their setting - with my child's face showing.
to be used on the services website/social media page, as an advertisement for their setting - only when my child's face is blurred out or obscured.
I give consent to all of the above

DECLERATION

I confirm that the details I have provided are accurate and correct and understand that the information provided on this form will assist staff in meeting my child’s individual care needs. I understand that any information I have provided is private and confidential. I agree to inform staff immediately of any changes to contact details or other personal information about my child.

Form Completed By *

Confirm Email *

Confirmation *I acknowledge that I have read and agree to all relevant terms & conditions, policies, and procedures

Signature *

Today's Date *

Important Notice for Summer Holiday Club

Child's Details

Parents / Carers Details

Mother's Details

Father's Details

Other Carer's Details

Childcare Arrangement

Dietary Requirements

Medical Information

Other Information

About Your Child

Likes, Dislikes & Favourite Things

Routines & Self-Care Skills

Further Information

Permissions

Photographs & Observations