ONLINE CLUB CONTACT FORM

This form is for children already booked into a club, for initial enquiries please use this form.

Please complete all the relevant information before your child's first session at Clare's Learning Club. If you have any issues completing the online form, please download the PDF version below.

clare’s_learning_club_contact_form_2022.docx
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Any information on this form is only held by Clare's Learning Club and will not be shared with any other companies. Any data held will be deleted 1 year after your child finishes at Clare's Learning Club.

Parent/ Guardian Contact Form

* Indicates required field

Please select *

I am happy with all of the below I am happy to receive updates about Clare's Learning Club Mailing list for year 5 revision sessions and mock test I am happy to added to a class WhatAspp group administrated by my child's teacher for homework updates and short notice information

Name of child *

First

Last

Current School Year *

Child's Date of Birth *

Parent/ carer name *

First

Last

Relationship to child *

Your email address *

Club attending *

School *

(Optional) Notes regarding Eleven Plus preparation so far (if any) *

(Optional) Other relevant learning information: *

Contact Information

Person responsible for paying invoice *

Billing Email Address if different from above *

Address *

Line 1

Line 2

City

State

Zip Code

Country

YEAR 5 ONLY: I give permission for my child to walk home alone after the class (face-to-face sessions) *

Contact Name 1 *

First

Last

Contact number 1 *

Emergency Contact Name *

First

Last

Emergency Contact Number *

People who will collect your child after the class (face-to-face sessions) *

Medical Conditions

Name of Doctor *

First

Last

Doctor's Address *

Line 1

Line 2

City

State

Zip Code

Country

Please list any medical conditions and/ or allergies: *

Medical Treatment (face-to-face sessions)

I the parent/ guardian named above give permission to the Clare's Learning Club teacher to administer any relevant minor treatment or medication to the above name participant when or if necessary.

Permission for minor treatment or medication *

I will make sure that I am contactable throughout the entire time that my child is at Clare's Learning Club, or that I have given the club's teacher the contact details of someone else who can be contacted, so that in a medical emergency situation my child can be quickly collected and give the necessary medical attention.

Sweets (face-to-face sessions)

I give permission for my child to eat a small amount of sweets during some sessions *

Please list any allergies or restrictions relating to sweets *

Squash/ Ice Lollies (face-to-face sessions)

I give permission for my year 4 child to make and drink a small amount of squash during a one off lesson on ratio.
I give permission for my year 5 child to have an ice lolly or ice cream after during the holiday sessions/ mock exam session.

Squash/ Ice Lollies *

Please list any allergies or restrictions relating to squash/ ice lollies/ ice cream: *

Online Session Rules

Online Session Etiquette - I have read and will go through these rules with my child. *

I and my child agree to the following online session rules based on pupil online code of conduct (see below):

Will not share the session link and password with anybody else.
Will login a few minutes before the session starts and wait to be admitted to the session.
My child will be set up somewhere quiet ideally sat at a table somewhere in the house where they can concentrate. Please turn any devices or sound in the same room off. They will remain seated unless they have permission to move around.
My child will raise their hand when they have a question.
If I need to speak to my child or my child needs to speak to me then we will use the mute button.
The video will remain on at all times unless agreed with teacher to turn off.
Only my child’s name or agreed name to be used on screen during sessions.
My child must be fully dressed during their session.
No snacks during sessions, they may have a drink.
No virtual backgrounds to be used.

Pupil online code of conduct taken from Clare’s Learning Club Safeguarding Policy
All parents who sign up with Clare’s Learning Club agree to the following code of conduct for their pupils involved in online sessions:
● Pupils will only receive online tutoring at the designated tutoring times and dates advertised by Clare’s Learning Club.
● Pupils will be dressed appropriately in either their uniform or appropriate attire for attendance at a school event.
● Pupils will conduct online tutoring either in a workplace or location that does not expose personal information.
● If broadband speed permits, pupils will keep their video stream ‘on’ for the duration of their sessions.
● Pupils will have any mobile phones on silent and out of gaze during sessions, or completely away as dictated by their school’s policy.
● Pupils will not record video, still images or audio of any tutoring sessions.
● Pupils will never disclose their phone, email or other communication details with their tutor nor request those of their tutor through the online platform.
● Pupils will not share any links to online content or websites that contain anything other than educational resources that directly link to the content of their sessions and Clare’s Learning Club work books.
● Pupils will not take any screenshots of sessions.
● Pupils consent to the recording and safe storage of online sessions for up to one term past the date of recording, unless recordings are deemed to be needed by the Designated Safeguarding Officer.
● Pupils consent to the monitoring of all online sessions by Clare’s Learning Club staff either live during the tutorial or afterwards in a systematic random review of safeguarding procedures.

Photography and Filming

I give permission for my child to be photographed or filmed at Clare's Learning Club for use on the Clare's Learning Club website, Facebook page and promotional materials. Occasionally some online sessions may be filmed to produce tutorials to be used at a later stage. During face-to-face sessions we may take photographs or videos of some games and activities.

Please select all or specify which you do or not give permission for.

All Media Listed Below *

Facebook *

YouTube *

Clare’s Learning Club Website *

Printed Materials ie posters and flyers *

Terms

I agree that fees will be paid in advance by the named person above before the start each half term and understand that unauthorised late payments will incur a £5 a week charge. *

CANCELLATIONS BEFORE STARTING AT CLARE'S LEARNING CLUB

If you cancel up to 7 days before your course starts, you'll receive a refund minus a £20 admin fee.
If you cancel within 7 days of the start of your course or once your course has started you will not be entitled to any credit or refund.
If you cancel, this must be received in writing by email.
Refunds are not issued for missed sessions unless in the unlikely event they cancelled by the club teacher.

I agree to the cancellation terms *

If you no longer wish your child to attend Clare's Learning Club once they have started attending

You must give at least three weeks written notice by email before the end of the current half term or you will receive a £20 admin fee.
If you wish your child to stop attending during a half term you will not receive a refund for the remainder of that half term.
If you have a monthly payment plan charges/ refunds will be calculated pro rata.

I agree to a written notice period of 3 weeks before the end of the half term or 4 weeks notice before a year 5 additional session. *

I have read the parent brochure that was emailed to me and agree to the terms. *

Are you happy to be added to a class WhatsApp group? For homework reminders and short notice information. *

If referred by a friend, please name them here: *

If Other please specify: *

Submit

Parent/ Guardian Contact Form

Contact Information

Medical Conditions

Medical Treatment (face-to-face sessions)

Sweets ​ (face-to-face sessions)

Squash/ Ice Lollies ​ (face-to-face sessions)

Online Session Rules

Photography and Filming

Terms

Sweets (face-to-face sessions)

Squash/ Ice Lollies (face-to-face sessions)