CC Registration Form – Quaggy Development Trust

GWCC Registration Form (1)

Step 1 of 4

Facebook
This field is for validation purposes and should be left unchanged.
This form must be completed before your child takes part in any children’s centre activity. (*=Required information)
Parent/Carer 1*
Title Forenames Surname
Family Address*
Street Address Address Line 2 City ZIP / Postal Code
Date of Birth*

Day
Month
Year
If Pregnant (Please Give the due Date)

Day
Month
Year
Gender*
Relationship to Child*
Ethnicity
Are you a lone parent?*
Are you an asylum seeker or refugee?
Phone*
Working status*
Email

Parent/Carer 2
Title Forenames Surname
Family Address (If different from above)
Street Address Address Line 2 City ZIP / Postal Code

Date of Birth

Day
Month
Year

If Pregnant (Please Give the due Date)

Day
Month
Year

Gender
Relationship to Child
Ethnicity
Are you a lone parent?
Are you an asylum seeker or refugee?
Phone
Working status
Email

Child Details (Click on the + button to add a child)
First Name Last Name Date of Birth Gender Ethnicity Address (if different from above) Additional needs or disability

Where did you hear about our Children's Centre?*

What is a Children’s Centre?

Children’s Centres offer all families with children under five a range of services, information and support in their local community. The support varies according to local needs but most centres offer the following:

- advice during pregnancy and when your baby is born
- home visiting
- family drop-ins
- parenting support
- information about your child’s health needs
- training courses to improve your life skills
- help finding specialist groups and services
- family support

Centres work closely with other local organisations, so if there is something they can’t help you with themselves, they will usually be able to give you details of an organisation who can. You can find out more information on Royal Borough of Greenwich Children’s Centres by visiting the Royal Greenwich website.

Declaration and signature:
Declaration and signature:

I agree to information about myself and my dependents, as outlined above, being kept on the Children’s Centre database and as a written record.

- I understand it will be updated on the database if my circumstances change.

- I understand that this information will be used for monitoring and evaluation purposes and for the effective provision of a range of Children’s Centre services to our family.

- I give permission for the Children's Centre to share this information with Greenwich Children and Young People's Service partners for the purpose of delivering its services only.

- I understand that the staff will sometimes take photographs/videos of the children at the many events and activities that go on at the Children’s Centres. Some of these photographs or videos will be used in newsletters, advertising and records of activities.

- I agree for photographs/videos of my children to be used in this way. (If you do not agree please speak to the Children's Centre Manager

- I give consent for the provider to contact me by telephone/text, post and email to provide information and support relating to Children’s Centre and childcare services which could benefit me and my family

- I understand that I do not have to give this agreement and it will not affect the other services that I receive and I can withdraw my agreement at any time.
Consent
Tick this box if you DO NOT consent to the use of photos
Consent to Contact*
Telephone Calls
Texts
Emails
Consent
Please tick this box to show your consent.
Consent for Parent 2 (If completed)
Please tick box to confirm consent has been given by Carer 2
Today's Date*

Day
Month
Year

GWCC Registration Form (1)

Step 1 of 4

Declaration and signature:

Support Us