Page 1 of 5 Registration Form 2023/24 - In Person Sessions 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 2023-24 SchoolPlease select... Benthal Primary School Bridge Academy Brook House Primary School Cardinal Pole Catholic School Chestnuts Primary School Devonshire Hill Primary Earlsmead Primary School and Children's Centre Gayhurst Community School Grasmere Primary School Hackney New School Haggerston School Lancasterian Primary School Lea Valley Primary School Lordship Lane Primary Morningside School Mulberry Primary School Petchey Academy Princess May Primary School Queensbridge Primary School Risley Avenue Primary School Sir Thomas Abney Shoreditch Park Primary St Francis De Sales Primary School St John the Baptist Primary School St Matthias CE Primary School The Willow Primary School William Patten Primary School Will your child be attending our Primary or Secondary sessions?PrimarySecondary Will your child be joining us at our Hackney or Haringey Ship? Hackney/DalstonHaringey/Tottenham Please choose the day that you would like your child to attend The Literacy Pirates sessions. We are aiming to offer days based on their popularity. Please note this is not a guarantee that your selected day will be available. We will confirm what day your child will be attending via phone call. Please select which days your child would be able to attend - they will only need to come one day a week. The sessions will be 4-6.30pmMondayTuesdayWednesdayThursdayFriday 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 Email Phone Number 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 Contact 3 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 Full Name Phone Number Email Travel arrangements FROM The Literacy Pirates - Please select all options that apply. My child has permission to travel from The Literacy Pirates alone.YesNo My child will be accompanied by: (Tick all that apply)MotherFatherSiblingCarerOther Family MemberFamily Friend Other (please specify) Page 2 of 5 We collect the following information to ensure that we meet your child’s needs on the programme. What is your child's first language? Does your child have special educational needs?YesNo If yes, please provide details (e.g. dyslexia) Does your child have 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)? Page 3 of 5 We collect the following information to measure the success of our programme against national statistics, to monitor diversity, and to ensure that we are doing our best for all children. The information is confidential and these questions are optional. Does your child receive free school meals?Please select... Yes No Prefer not to say What is the sex of your child?Please select... Male Female Prefer not to say Does your child identify with the sex they were registered with at birth?Please select... Yes No Prefer not to say Please enter their gender identity here: 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 Asian, White Mixed Black, White Mixed Other Turkish White British White Other Other Prefer Not to Say Page 4 of 5 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 walking trips in the local area, accompanied by Literacy Pirates staff and volunteers. We will let you know in advance of this happening. 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. I consent to the above Terms and ConditionsYes Photo Consent As part of the learning programme, your child will receive opportunities to contribute to products, published by The Literacy Pirates, including books and films. This is an exciting part of the programme for Young Pirates as it consolidates their learning and provides them with a product to keep as evidence of their achievements. These products will only be shared at closed events for the children, their families, their teachers and our funders, with your consent. I give permission for photographs and video footage to be used/included in our Young Pirate products, such as a published book and movie.YesNo As a charity, we need to market our work in order to raise funds; recruit staff and volunteers; and form new partnerships with schools. This sometimes requires us to take photographs and videos our sessions to share in publicity material, where we have your consent. I 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, LinkedIn, YouTube).YesNo 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. Signed (Full Name) Relationship to child: Date Page 5 of 5 Evaluation We collect the following information to track how well children do on the programme. The information is confidential. Section 1: Grit “Grit” is high motivation and care for work and being able to keep going.Using the above definition please rate your child’s “grit” on a scale of 0 to 100. 0-100 Section 2: Reading How do you think your child would describe themselves? 1 - not a very good reader2 - an average reader3 - a very good reader How many books does your child own?01-45-910-1920+ What do you hope your child achieves in their time at the Literacy Pirates? This question is optional. We will share the answer with their Session Leader on the programme. Thank you for completing this form!Please press the Submit button below to send the form to us. Contact Information
