Cofrestri

Clwb Carco - Ffurflen Gofrestru / Registration Form 2017 - 2018

Enw Clwb / Name of Club :

Dyddiad dechrau Clwb Carco / Start date for Clwb Carco:

**Ni chaniateir i unrhyw blentyn mynychu Clwb Carco cyn derbyn Cytundeb Rhieni yn ôl wedi’u arwyddo**

**No child will be allowed to attend Clwb Carco unless Parent Contract is signed and returned**

Enw’r Plentyn / Child’s Name:

Dyddiad Geni/Date of Birth:

Cefndir Ethnig / Ethnic Origin:

Iaith y Cartref/Home Language:


Manylion Cyswllt / Contact Details

Enw / Name:

Perthynas i’r plentyn / Relationship to child:

Cyfeiriad adref / Home address:

Rhif ffôn adref / Home telephone no.:

Rhif ffôn symudol / Mobile telephone no.:

Man gwaith / Workplace:

Rhif ffôn gwaith / Work telephone no.

Nodwch unrhyw anghenion arbennig a sut rydym yn gallu helpu’ch plentyn /
Please note any Special needs and how we can help your child 
 

Gwybodaeth Meddygol / Medical Information

Meddyg teulu / Family Doctor

Cyfeiriad / Address

Rhif ffôn / Telephone number

Gofynion Meddygol / Deietegol - yn cynnwys unrhyw alergeddau / anoddefiad ac unrhyw triniaeth
Medical and Dietary requirements - including any allergies / intolerances and treatments


Cyswllt mewn Argyfwng / Emergency contacts

Cyswllt 1 / Contact 1

Enw / Name

Perthynas i’r plentyn / Relationship to child

 
Cyfeiriad adref / Home address
 

Rhif ffôn adref / Home telephone no.

 
Rhif ffôn symudol / Mobile telephone no.

Rhif ffôn gwaith / Work telephone no.

 
Mewn argyfwng os nad oes modd cysylltu â’r uchod, rhoddaf ganiatâd i fy mhlentyn dderbyn y canlynol:
In an emergency, if unable to contact the above, I give permission for the following:

Triniaeth meddygol argyfwng
Emergency medical treatment

Triniaeth deintyddol argyfwng
Emergency dental treatment

 

Oedolion â chaniatâd i gasglu eich plentyn / Adults with permission to collect your child

Am resymau amddiffyn plant, gofynnwn i chi nodi cyfrinair rhag ofn na fyddwch yn gallu casglu eich plentyn a bydd rhaid i rywun arall casglu nhw. Sicrhewch bod yr oedolion a restrir yn ymwybodol o'ch cyfrinair. Mi fydd y staff yn gofyn i’r oedolyn sydd yn casglu eich plentyn am y cyfrinair.

For child protection reasons we ask that you note a password in case you are unable to collect your child and someone else has to. Please make sure that the listed adults are aware of your password. Staff members will ask the adult collecting your child for the password.

Adult 1

Enw / Name

Perthynas i’r plentyn / Relationship to child

Cyfrinair / Password


Caniatâd / Permission

Nodwch eich dewisiadau isod / Please note your choices below

Lluniau Trydar /Pictures for Twitter

Lluniau marchnata a hyrwyddo / Marketing and promotional pictures

Peintio gwyneb / Face painting

Eli haul / Sun Lotion

Teithiau lleol – hysbysebir rhain cyn mynd
Local trips – these will be advertised before going

 

Sessiynnau / Sessions:

Nodwch cyfanswm pris sessiynnau
(mae prisoedd sessiynnau unigol ar gael o wybodaeth bob Clwb Carco unigol ar y wefan)

Please note total price of sessions:
(prices for individual sessions are listed on individual Clwb Carco on the website)

       
*dylid nodi mae gostyngiad i’r pris os bwriedir talu trwy archeb sefydlog*
*please note there is a slight reduction in price if you intend to pay using a Standing Order*


Ffordd o Dalu / Method of Payment 

Payment Reference

 

Hawlfraint@Menter Iaith Rhondda Cynon Taf
2017 Menter Iaith RhCT. Rhif elusen gofrestredig: 1053135