Sign Up Form - North Lincolnshire Council Council

Your Details
Child Details
Consent
Emergency Contact
Other

Please remember your registered email and password, as this will be used to access the Fuelled website.

All fields marked * are required and must be filled in.

Email *

Confirm Email *

Email must match

Password *

At least 8 characters
At least 1 uppercase character
At least 1 lowercase character
At least 1 special character
At least 1 number

First name *

Last name *

Address Line 1 *

Address Line 2

Town *

County *

Postcode *

Daytime Phone Number *

Mobile Number

Confirm that you are the parent or guardian of the child you are signing up *

How many children would you like to register? *

Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child Unique Code (as per letter) *

Child First name *

Child Last name *

Child Preferred Name

Child Date of Birth *

School *

Spoken Language *

Child Ethnicity *

Do you require someone other than yourself to collect your child from the Holiday Activity Programme? *

Yes

I give permission to the following person/s to collect my child from the Holiday Activity Programme in my absence *

Name of person/s collecting your child *

Security Password *

Does your child have any special educations needs or disabilities (SEND)? If yes, please explain?

Yes

Does your child have an Education Health and Care Plan (EHCP)? If so, please upload it. *

Yes

Does your child have an up to date short breaks passport? If so, please upload it. *

Yes

Does your child have personal care needs? If yes please explain these, including what support they will require in as much detail as possible. *

Yes

Does your child have any medical needs? If so, what are they? *

Yes

What dietary needs does your child have?

Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10

Once registering your child we will need to share your child’s personal information with ONLY providers who deliver the Activity and Holiday programme and ONLY for the purpose of the delivery of the programme.

We will be using your registration/consent for any future upcoming events for the holiday programme over 2024.. If you would not like to be contacted about this programme in the future please contact fuelled@northlincs.gov.uk

I understand this consent will be used for any upcoming holiday programme events during 2024 *

I understand and agree to you sharing my and my child’s personal information with ONLY providers involved in the delivery of the Activity and Holiday programme and ONLY for the purpose of the delivery of the programme, access to book activities and the completion of occasional surveys to improve the programme.

It is recommended that you consult with your doctor before your child begins any exercise program but particularly if you are aware that they have any underlying medical conditions. These should be declared on the enrolment form. They should be in good physical condition and be able to participate in the advertised activity. *

I confirm that my child in my care may take part in any physical activity. North Lincolnshire Council Council cannot be held responsible for any damages to my child or property that may occur as a result of undisclosed personal details. *

I give permission for the child to take part in any activity organised as part of the programme unless it has been specifically prohibited by me, in writing, in advance.

I hereby give permission for North Lincolnshire Council Council to use any photographs or video footage captured of us at this event for use in press, publicity or on social media channels.