Sign up your child for online sessions Registration Form 2022/23 - Online Sessions Please note, this registration form is for Online Sessions only. Your Child's Details First Name Last Name First Letter of First Name First Letter of Last Name Home Address Postal Code City Date of Birth Year Group 2022-23 SchoolPlease select... Barking Abbey School Christ Church CofE Primary School Dunraven School Goresbrook School Primary Richard Atkins Primary School Stoke Newington School Tubbenden Primary School Winston Way Academy Will your child be attending our Primary or Secondary sessions?PrimarySecondary Primary Sessions will be taking place online from home on Mondays, Wednesdays Thursdays or Fridays (4pm to 6pm).Please select... Monday Wednesday Thursday Friday Secondary Sessions will be taking place online from home on Thursdays (4pm to 6pm).Please select... Thursday Your child will need to use a laptop or computer to join their sessions. Would you like us to lend you one?YesNo Your child will need a computer or laptop to join the session. We have a limited number of laptops that we can provide to those who need them. If your child has no access to a laptop and would need one provided, please tick here:YesNo Please provide 3 contacts for your child, in the order we should call if we need to contact you. Contact 1 First Name Last Name Relationship to ChildPlease select... Aunt Father Grandfather Grandmother Mother Other Brother Step-father Step-mother Uncle Family Worker Cousin Foster Carer Family Friend Guardian Godmother Godfather Sister Phone Number Email Contact 2 Full Name Relationship to ChildPlease select... Aunt Father Grandfather Grandmother Mother Other Brother Step-father Step-mother Uncle Family Worker Cousin Foster Carer Family Friend Guardian Godmother Godfather Sister Phone Number Email Contact 3 Full Name Relationship to ChildPlease select... Aunt Father Grandfather Grandmother Mother Other Brother Step-father Step-mother Uncle Family Worker Cousin Foster Carer Family Friend Guardian Godmother Godfather Sister Phone Number Email We are keen to ensure that we are providing equal opportunities for all. The following information will be treated as confidential. Gender First Language Ethnic Group. Please choose from one of the following: Arab Asian (Indian, Pakistani, Bangladeshi, Chinese) Asian British Asian Other Black African, Caribbean Black British Black Other Kurdish Latin American Mixed Black, White Mixed Other Turkish White British White Other Other Prefer Not to Say Is your child eligible for Pupil Premium funding?YesNo Does your child have special educational needs?YesNo If yes, please provide details (e.g. dyslexia) Does your child suffer from any allergies?YesNo Details, including medication given (please be specific) Does your child have any medical conditions?YesNo Details, including medication taken (please be specific) Is there any other information useful for us to know (educational/social/emotional/behavioural)? Consent and AgreementLearning Sessions I give permission for my child to attend The Literacy Pirates After-School Sessions and consent to my child working with Literacy Pirates staff and volunteers. I acknowledge that my child needs to attend the weekly sessions they sign up to, and that I must give at least 3 hours’ notice of cancellation if they are unable to attend. I support good behaviour in sessions and will discuss any issues with Literacy Pirates staff. I give permission for short trips in the local area, accompanied by Literacy Pirates staff and volunteers. Publishing I give non-exclusive licence for The Literacy Pirates to use the contributions of my child (which my child owns the rights to) towards their charitable aims, granting consent required by law for their use both now and in the future. I waive and agree not to assert, any so-called “moral rights” or other non-transferable rights that I may have in relation to the contribution as my child will be given suitable author credit. Library I understand that if my child does not return books to The Literacy Pirates Library that they may be stopped from borrowing books. I will report any books my child loses. Evaluation I agree to contribute to The Literacy Pirates Monitoring and Evaluation strategy by completing termly questionnaires about my child’s progress. Privacy I agree to The Literacy Pirates privacy policy, which is available at www.literacypirates.org . I understand they will never sell my information or the information of my child. I understand that they collect information to support my child on the programme and that information that will help support my child is shared between school and The Literacy Pirates. Photo PermissionI give permission for photographs and video footage of my child to be used by The Literacy Pirates for the learning programme and for their charitable aims, in both displays and online on our website and social media (Twitter, Instagram, Facebook). ***This will include their photo being used/included in our Young Pirate products, such as our published book and movie. If you have any special requirements regarding photo consent for your child, please get in touch. We will record them and ensure they are met. You can reach us at 07912 178037.*** I give Photo PermissionYesNo I, or an adult who I trust, will be present during my child's online Literacy Pirates session as part of our safeguarding agreement. I am aware that Literacy Pirates staff are also present online and will be dropping into all volunteer-led breakout rooms.Please Tick I consent to the above Terms and ConditionsYes Signed (Full Name) Relationship to child: Date Contact Information
