Klabb 3-16 / Skolasajf Registration Form (English)

Welcome toKlabb 3-16 / Skolasajf 2014!

22586818

klabb316.mede@gov.mt

facebook.com/FoundationforEducationalServices Foundation for Educational Services,P.O. Box 1, Rabat RBT 1000, Malta

Once again the Foundation for Educational Services welcomes you to Klabb 3 -16 and Skolasajf – a summer programme full of educational and fun activities for children aged between 3 and 16. Parents can make use of any Klabb 3 -16 or Skolasajf centre according to their needs. Klabb 3-16 Sajf is part of Klabb 3-16, an after-school service which runs throughout the year. The services are open to children attending State, Church or Independent Schools. For more information, please use the contact details provided above.

Summer Service Provision: Service Break: Opening Hours:

From the 7 July to the 17 September 2014 11 - 15 August 2014 Klabb 3-16:Monday to Friday, 7.00 am - 5.30 pm Skolasajf: Monday to Friday, 8.30 am - 12.30 pm

REGISTRATION & PAYMENT MALTA Registration Days: From Monday 26 May to Wednesday 28 May 2014 Time: 8.30 am – 1.00 pm / 1.45 pm – 6.00 pm Venues for Registrations:  Mosta: Maria Regina Boys’ Secondary School Kulleġġ (Ta’ Żokrija), Triq il-Biedja  Floriana: Customer Care Section, Directorate for Educational Services, Great Siege Road  Qormi: St Ignatius College, The Office of the College Principal Federico Maempel Square  Żabbar: Civic Centre, Ċawsli Street

GOZO Registration Days: From Monday 2 June to Wednesday 4 June 2014 Time: 8.30 am – 1.00 pm / 1.45 pm – 6.00 pm Venue for Registration: Gozo College, The Office of the Principal, Europe Street, Victoria Klabb 3-16 Centre (Please choose one  of these centres for service between 7:00am and 5:30 pm) Attard 21410350 Floriana 21221939

B’Bugia 21653221 Ħamrun Ġ. Pace 21235301

B’Kara 21493459 Luqa 21257096

Cospicua 21804561 Mellieħa 21521659

Fgura 21665692 Mġarr 21574016

Mosta 21585070

M’Scala 21632001

Naxxar 21423550

Paola 21803510

Pembroke 21363053

Qormi San Ġorġ 21443161

Rabat 21452306

San Ġwann 21385223

Siġġiewi 21460938

Sliema 21312806

Sta. Venera 21497058

St Paul’s Bay 21573495

Valletta 21220108

Żabbar 21663203

Żebbuġ 21461736

Żejtun 21804047

Żurrieq 21650789

Nadur 21550333

Victoria 21558057

Skolasajf Centre (Please choose one  of these centres for service between 8:30am and 12:30 pm) For these centres, please call 22586818 Burmarrad

Dingli

Għargħur

Għaxaq

Gudja

Gżira

Kalkara

Kirkop

Lija / Balzan

Marsa

Mqabba

Msida

Mtarfa

M’Xlokk

Pietà

Qormi San Bastjan

Qrendi

Safi

Senglea

Tarxien

Xgħajra

Guardian Angel Resource Centre (Ħamrun)

Helen Keller Resource Centre (Qrendi)

San Miguel Resource Centre (Pembroke)

Dun Manwel Attard Resource Centre (Wardija)

Għajnsielem

Għarb

Kerċem

Qala

San Lawrenz

Sannat

Xewkija

Żebbuġ

Sannat Unit, Resource Centre (Sannat)

Summer Programme Number of Days per Week

1 ☐

2 ☐

3 ☐

4 ☐

5 ☐

Please mark ( ) those days when your child/ren will be using one of the centres.

Monday

Tuesday

Wednesday

Thursday

Friday

1st Child 2nd Child 3rd Child The core hours for the Summer Programme are between 8:30am and 12:30pm. Do you need extra hours of service? Yes ☐ No ☐ The fee per child is €25 for the whole Summer Programme from Monday and Friday between 8:30 am and 12:30 pm. The hourly rate for extra hours of service is €0.80c per hour.

Please indicate the number of hours of service you need in the table below. (For example, from 7:00 am to 12:30 pm).

Monday

Tuesday

Wednesday

Thursday

Friday

1st Child

From

To

From

To

From

To

From

To

From

To

2nd Child

From

To

From

To

From

To

From

To

From

To

3rd Child

From

To

From

To

From

To

From

To

From

To

Extra hours

10 = €8 ☐

30 = €24 ☐

50 = €40 ☐

For Office Use Only €25 + Extra Hours Bundle € ___ = Total € ___

2

Personal Details 1st Child Surname

________________

Name

Date of Birth

______________

Child lives with

Parent 1 ☐

School

___________________________________________________________________

Allergies

Specify

☐

None

☐

Medical Condition

Specify

☐

None

☐

Disability

Specify

☐

None

☐

Special Circumstances

Specify

☐

None

☐

Age

_______________ ____

Parent 2 ☐

Both ☐

ID Card

___________

Language/s

______________________

Others ☐

______________________

2nd Child Surname

________________

Date of Birth

______________

Name

Child lives with

Parent 1 ☐

School

___________________________________________________________________

Allergies

Specify

☐

None

☐

Medical Condition

Specify

☐

None

☐

Disability

Specify

☐

None

☐

Special Circumstances

Specify

☐

None

☐

Age

Parent 2 ☐

_______________ ____ Both ☐

ID Card

___________

Language/s

______________________

Others ☐

______________________

3rd Child Surname

________________

Date of Birth

______________

Name

Child lives with

Parent 1 ☐

School

___________________________________________________________________

Allergies

Specify

☐

None

☐

Medical Condition

Specify

☐

None

☐

Disability

Specify

☐

None

☐

Special Circumstances

Specify

☐

None

☐

Age

_______________ ____

Parent 2 ☐

Both ☐

ID Card

___________

Language/s

______________________

Others ☐

______________________

PARENTS’ / GUARDIANS DETAILS PARENT 1 Surname: Mobile No: Email Address:

_________________

Name:

_______________

ID Card:

____________

_________________

Home No:

_______________

Work No:

____________

__________________________________________________________________ Postal Code:

Address: Relationship with Child?

_______________________________

____________

Language/s:______________________ 3

PARENT 2 Surname: Mobile No: Email Address:

_________________

Name:

_________________

Home No:

______________

ID Card:

____________

______________

Work No:

____________

__________________________________________________________________ Postal Code:

Address: Relationship with Child?

_______________________________

____________

Language/s:______________________

CUSTODY ACCESS Name of person who has custody of child:

____________________________________________

Is there a Court Order? If YES, please speak to Centre Coordinator.

Yes ☐

No ☐

PHOTOS / FOOTAGE Permission is hereby granted to Klabb 3 -16 and FES to use photos and footage of children in promotional material.

Yes ☐

No ☐

IN CASE OF EMERGENCY PLEASE CONTACT THE PERSON/S LISTED BELOW BESIDES THE PARENTS 1st Person

2nd Person

Name & Surname:

_______________________________________________

ID Card No:

______________

Mobile No:

______________

Home Tel No:

______________

Work Tel No:

______________

Relationship with Child/ren

_______________________________________________

Name & Surname:

_______________________________________________

ID Card No:

______________

Mobile No:

______________

Home Tel No:

______________

Work Tel No:

______________

Relationship with Child/ren

_______________________________________________

The following documents rae to be presented with this application form:

For Office use only

Copy of ID card of Parent/s and/or Guardian/s

☐

Ref. No: ______________

Copy of the ID Card of person/s authorised to pick up the child/ren

☐

Date of Registration: ______________

Statementing Board Report (if applicable)

☐

Receipt No: ______________

Custody documents (if applicable)

☐

Paid by Cheque ☐ No: ____________ Cash ☐Amount paid: €___________ Signature of FES personnel:

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