"*" indicates required fields Family Support Wales community service provision is providing a Saturday Morning Club for children aged 5 to 12 years old at Coleshill Centre, Coleshill Terrace, Llanelli, SA15 3BT. 9am – 12pm on Saturday's from 2nd March 2024. The joining Fee is £10.00 per Saturday (non-refundable). Coleshill Centre is offered by Carmarthenshire Council and includes arts and crafts if needed. All activities are completed with FSW staff as part of our Community Service Support Program and are planned in advance when needed, with the consent of the person responsible for each venue. Please complete the form below to book a date or dates. Completing the form will also require a PayPal payment of the £10 joining fee (per Saturday booked). Payments are non-refundable, so please ensure you are able to attend before booking. Club BookingSaturday Morning Club Bookings Please select the date or dates you would like to book for the Saturday Morning Club. The fee is £10 (per session). Due to high demand the club is booked on a first come first serve basis. Snacks and drinks are not provided in the clubMarch 2024 Saturday 9th March Saturday 23rd March April 2024 Saturday 13th April Saturday 20th April Saturday 27th April May 2024 Saturday 4th May Saturday 11th May Saturday 18th May Saturday 25th May June 2024 Saturday 8th June Saturday 15th June Saturday 22nd June Saturday 29th June July 2024 Saturday 6th July Saturday 13th July September 2024 Saturday 7th September Saturday 14th September Saturday 21st September Saturday 28th September October 2024 Saturday 5th October Saturday 12th October Saturday 19th October Saturday 26th October November 2024 Saturday 9th November Saturday 16th November Saturday 23rd November Saturday 30th November December 2024 Saturday 7th December Saturday 14th December Saturday 21st December January 2025 Saturday 11th January Saturday 18th January Saturday 25th January February 2025 Saturday 1st February Saturday 8th February Saturday 15th February Saturday 22nd February Young PersonName* First Last Address Street Address Address Line 2 Town or City Postcode Date of Birth* Ethnicity Gender Male Female School Pictures and Consent Picture Consent Family Support Wales are able to offer photo feedback service for you to see where and what we do when we support your child or family member. With consent we will take pictures of the activities we complete with your child and share them with you. These will be appropriate and sensitive and will aim to build a picture profile of positive times and activities your child has enjoyed. Only senior staff or allocated staff will be sanctioned to take pictures. No photos will be stored for their personal use. Every picture will be stored at the office for use with the agreement of you and only shared with you and/or with others with your consent. Storage of these pictures will comply with our Data Protection Policy, Confidentiality Policy and our Sharing Information Policy. Social Media Consent FSW uses social media to share positive experiences experienced by those we support with others. Sharing through this medium allows families to share the activities we do with their children with their family and friends. FSW uses social media to promote the good work of staff and the overall positive experiences of those we support. Picture of your child*It would be appreciated if you are able to upload a picture of your child please as this will help us to quickly identify them when they attend Club.Max. file size: 256 MB.Legal Responsibility Confirmation*As the below named parent/guardian I can confirm that I have the legal responsibility for this child/adult and legal authorisation to give consent for the person named above. I have the legal responsibility for this child/adult and legal authorisation to give consent I DO NOT have the legal responsibility for this child/adult or legal authorisation to give consent Picture Consent*As the below named parent/guardian I can confirm that I have the legal responsibility for this child/adult and legal authorisation to give consent for the person named above to allow specific Family Support Wales staff to take their picture. The picture shall respect the persons decency, protective rights and be respectful at all times. I consent to pictures being taken I DO NOT consent to pictures being taken Social Media Consent*As the below named parent/guardian I can confirm that I have the legal responsibility for this child/adult and legal authorisation to give consent for FSW to share the pictures on its social media pages that are Facebook, Instagram, and Twitter. The picture shall respect the persons decency, protective rights and be respectful at all times. I allow FSW to share pictures on social media I DO NOT allow FSW to share pictures on social media Parent/CarerParent/Carer Name* First Last Relationship* Home Telephone number* Work Telephone number Mobile Telephone number Parent/Carer Email address*This is used to send confirmation Parental Responsibility?* Yes No Same address as young person? Yes No Parent Carer Address*Please enter the parent/carer address IF DIFFERENT from the young person's address. Street Address Address Line 2 Town or City Postcode Second Parent/CarerParent/Carer Name (Second Parent/Carer) First Last Relationship (Second Parent/Carer) Home Telephone number (Second Parent/Carer) Work Telephone number Mobile Telephone number (Second Parent/Carer) Email address (Second Parent/Carer) Parental Responsibility? (Second Parent/Carer) Yes No Same address as young person? (Second Parent/Carer) Yes No Parent Carer Address (Second Parent/Carer)Please enter the parent/carer address IF DIFFERENT from the young person's address. Street Address Address Line 2 Town or City Postcode Addtional Emergency ContactEmergency Contact Name* First Last Emergency Contact Relationship Emergency Contact Telephone number* Emergency Contact Mobile number Surgery Medical conditions*Medication (where relevant)*Does your child have a social worker? Yes No Social Worker Name Social Worker Contact Telephone Does he/she have any allergies (e.g. food, drink, animals, etc) or hypersensitivity (e.g. sound, light) that we need to be aware of?* Yes No Please tell us about the allergies (if applicable)Are there any foods or drink items which should not be given?* Yes No Please tell us about the foods or drinks items which should not be given (if applicable)Does He/she need assistance with personal hygiene and tolieting?* Yes No If yes, what assistance is needed?*Does he/she display any behaviours that may challenge?* Yes No If yes, please explain further and how you would normally help the situation*ConsentDo you give permission for the young person to be photographed/videoed for display purposes/promotional materials including our website, brochures and the local press? Yes No Do you give permission for the young person to have first aid administered in the event of an accident/injury? Yes No Do you give permission for us to contact your social worker? Yes No I give consent to Family Support Wales to keep the information I submit with this form. I understand this information will be stored safely and used as a part of an ongoing pen picture of the child/young person that will support future day trips and services. Yes No Thank you for completing it as thoroughly as possible. Clicking the SUBMIT button below will direct you to PayPal to pay the £10 booking fee (per Saturday booked). Please be aware that payments are non-refundable, so please ensure you are able to attend before booking. Please note that you don't need a PayPal account in order to make a payment using PayPal. EmailThis field is for validation purposes and should be left unchanged.