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Registration Form 2024/25 - In Person Sessions

Your Child's Details

First Name

Last Name

First Letter of First Name

First Letter of Last Name

Home Address

Postal Code

City

Date of Birth

Year Group 2024-25

School

Will your child be attending our Primary or Secondary sessions?

PrimarySecondary

Please choose the day that you would like your child to attend The Literacy Pirates sessions. We are aiming to offer days based on their popularity. Please note this is not a guarantee that your selected day will be available. We will confirm what day your child will be attending via phone call. Please select which days your child would be able to attend - they will only need to come one day a week. The sessions will be 4-6.30pm

Please provide 3 contacts for your child, in the order we should call if we need to contact you.

Contact 1

First Name

Last Name

Relationship to Child

Phone Number

Email

Contact 2

Full Name

Email

Phone Number

Relationship to Child

Contact 3

Relationship to Child

Full Name

Phone Number

Email

Travel arrangements FROM The Literacy Pirates - Please select all options that apply.

My child has permission to travel from The Literacy Pirates alone.

YesNo

Other (please specify)

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We collect the following information to ensure that we meet your child’s needs on the programme.

What is your child's first language?

Does your child have special educational needs?

YesNo

If yes, please provide details (e.g. dyslexia)

Does your child have any allergies?

YesNo

Details, including medication given (please be specific)

Does your child have any medical conditions?

YesNo

Details, including medication taken (please be specific)

Is there any other information useful for us to know (educational/social/emotional/behavioural)?

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Consent and Agreement

Learning Sessions

I give permission for my child to attend The Literacy Pirates After-School Sessions and consent to my child working with Literacy Pirates staff and volunteers.
I acknowledge that my child needs to attend the weekly sessions they sign up to, and that I must give at least 3 hours’ notice of cancellation if they are unable to attend.
I support good behaviour in sessions and will discuss any issues with Literacy Pirates staff.
I give permission for short walking trips in the local area, accompanied by Literacy Pirates staff and volunteers. We will let you know in advance of this happening.

Publishing

I give non-exclusive licence for The Literacy Pirates to use the contributions of my child (which my child owns the rights to) towards their charitable aims, granting consent required by law for their use both now and in the future.
I waive and agree not to assert, any so-called “moral rights” or other non-transferable rights that I may have in relation to the contribution as my child will be given suitable author credit.

Library

I understand that if my child does not return books to The Literacy Pirates Library that they may be stopped from borrowing books. I will report any books my child loses.

Evaluation

I agree to contribute to The Literacy Pirates Monitoring and Evaluation strategy by completing termly questionnaires about my child’s progress.

Privacy

I agree to The Literacy Pirates privacy policy, which is available at www.literacypirates.org .
I understand they will never sell my information or the information of my child.
I understand that they collect information to support my child on the programme and that information that will help support my child is shared between school and The Literacy Pirates.

I consent to the above Terms and Conditions

Yes

Photo Consent

As part of the learning programme, your child will receive opportunities to contribute to products, published by The Literacy Pirates, including books and films. This is an exciting part of the programme for Young Pirates as it consolidates their learning and provides them with a product to keep as evidence of their achievements. These products will only be shared at closed events for the children, their families, their teachers and our funders, with your consent.

I give permission for photographs and video footage to be used/included in our Young Pirate products, such as a published book and movie.

YesNo

As a charity, we need to market our work in order to raise funds; recruit staff and volunteers; and form new partnerships with schools. This sometimes requires us to take photographs and videos our sessions to share in publicity material, where we have your consent.

I give permission for photographs and video footage of my child to be used by The Literacy Pirates for the learning programme and for their charitable aims, in both displays and online on our website and social media (Twitter, Instagram, Facebook, LinkedIn, YouTube).

YesNo

If you have any special requirements regarding photo consent for your child, please get in touch. We will record them and ensure they are met. You can reach us at 07912 178037.

Signed (Full Name)

Relationship to child:

Date

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Evaluation

We collect the following information to track how well children do on the programme. The information is confidential.

Section 1: Grit

"Grit" is high motivation, care for work, and being able to keep going. Please rate your child's "grit" on a scale of 0 to 100 (where 0 is the lowest and 100 the highest)

0-100

What do you hope your child achieves in their time at the Literacy Pirates? This question is optional. We will share the answer with their Session Leader on the programme.

Thank you for completing this form!
Please press the Submit button below to send the form to us.

Arab	Asian (Indian, Pakistani, Bangladeshi, Chinese)
Asian British	Asian Other
Black African, Caribbean	Black British
Black Other	Kurdish
Latin American	Mixed Asian, White
Mixed Black, White	Mixed Other
Turkish	White British
White Other	Other
Prefer Not to Say