Sign up your child for in person sessions Registration Form 2022/23 - 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 2022-23 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 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 Please choose the day that you would like your child to attend The Literacy Pirates sessions. Please note that there will be no Hackney sessions on Tuesdays and no Haringey sessions on Thursdays.Primary - Day Choice 1Please select... Monday Tuesday Wednesday Thursday Friday Please choose the day that you would like your child to attend The Literacy Pirates sessions.Secondary - Day Choice 1Please select... Monday Tuesday 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 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) 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)? Learning 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.*** Consent and Agreement I consent to the above Terms and ConditionsYes I give Photo PermissionYesNo Signed (Full Name) Relationship to child: Date Contact Information
