Kim Club Record Form

Even if you do not plan to use the Kim Club facilities, we request that parents of all Preparatory School children complete the following in order to comply with statutory requirements. Thank you for your co-operation. Our Privacy Notice may be found here.

In the event of my child attending the Kimbolton School Kim Club the following information is provided:

Child's Details

Child's Full Name* Preferred Name* Date of Birth* Home Address* Home Telephone Number* Mother's Mobile Number* Father's Mobile Number

Emergency Contact Details When Kim Club Is Operational:

(1) Name* Telephone Number* (2) Name* Telephone Number*

Details Of Anyone Else Authorised To Collect Your Child:

(1) Name Telephone Number Address (2) Name Telephone Number Address Please provide a password for security purposes if necessary:*

I consent to any emergency medical treatment necessary during the running of Kim Club and authorise the staff to sign any form of consent required by medical staff, if a delay in obtaining my signature could endanger the child’s health or safety. I agree to abide by the terms and conditions of Kim Club.

Signed (Parent/Guardian - please type your name below)* Date*

Kim Club Record Form

Child's Details

Emergency Contact Details When Kim Club Is Operational:

Details Of Anyone Else Authorised To Collect Your Child:

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