Early Years Scotland Group Associate Membership & Insurance Application Form

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1 Early Years Scotland Group Associate Membership & Insurance Application Form 1 April March 2016 The notes beside each question will assist you to understand the application form. PLEASE READ THEM CAREFULLY. Incorrectly completed forms cause delay to your application and add to the cost of administration both to Early Years Scotland and to your Setting. If you are unsure about any part of the form, please contact Early Years Scotland between 10.00am and 2.30pm, Monday to Friday, telephone Please ensure that all sections of the form are completed as fully as possible. At our busiest time (March-May), please allow six weeks from receipt for processing of your membership. Your insurance cover will begin on the date that the correctly completed application form and payment is received. Q1: Name of Setting Please print the name of your Setting:... wishes to be an Associate Member of Early Years Scotland and supports the aims of the company. Q2: Type of Setting Please tick ONE of the boxes to enable us to quickly identify the type of provision your Setting offers: A: Out of School Care A setting offering care for predominantly primary school age children before and/or after school and/or during school holidays. B: Childcare Setting A childcare setting for predominantly primary school age children, with less than 50% children 5 years of age or under. Session lasting 0-4 hours. C: Childcare Setting A childcare setting for predominantly primary school age children, with less than 50% children 5 years of age or under. Session lasting 4-6 hours D: Childcare Setting A childcare setting for predominantly primary school age children, with less than 50% children 5 years of age or under. Session lasting over 6 hours. E: Playscheme A group offering holiday care for predominantly primary school age children during school holidays. session lasting 0-4 hours. F: Crèche An Early Learning and Childcare group where children are unaccompanied by their parents and use the facility on an ad-hoc basis. session lasting 0-4 hours. Form produced February 2015

2 Q3: Name, Address, and Telephone Number of Contact Person The contact person will receive mailings from Early Years Scotland. Please advise Early Years Scotland, in writing, or via , of any changes during the year. This will ensure that your Setting does not miss out on important information. Please complete the contact person s name, address, daytime telephone number and address in block capitals below. This will only be used by Early Years Scotland personnel. Name of Setting s contact person:... Address Daytime tel no Position in organisation (e.g. chair, secretary, owner, manager etc)... Q4: Group Associate Membership Criteria and Subscriptions Early Years Scotland Group Associates must comply with the following criteria: a) the Setting must be registered with the Care Inspectorate b) the Setting must operate within the appropriate Early Years Scotland Code of Practice. Playschemes and Out of School Care Settings (both sessional and all day) do not qualify for Early Years Scotland Membership, they qualify for Group Associate Membership only. Please tick the box to confirm the Setting has appropriate registration with the Care Inspectorate. The Setting will comply with the following criteria: Registration - the Setting is registered with the Care Inspectorate for the services it provides. Note: Early Years Scotland does not admit unregistered groups as Associates or give insurance cover to unregistered groups. Please note that Early Years Scotland has the right to refuse applications. Please tick the relevant box which corresponds with the type of group and then enter amount in question 9 of 1) SUBSCRIPTION and 2) INSURANCE and then the total amount being sent. A: Out of School Care 109 B: Childcare Setting, 0-4 hours 82 C: Childcare Setting, 4-6 hours 87 D: Childcare Setting, over 6 hours 134 E: Playscheme, 0-4 hours 77 F: Crèche, 0-4 hours 77

3 Q5: Type of Premises and Operating This information is necessary for our records. Name of Chairperson/Owner... Type of premises: eg. school, community centre, church... Local Authority area... Full postal address of premises Postcode... Premises tel no... Premises ... If your Setting meets in more than one place, please give other addresses below: Please note that each set of premises requires its own insurance cover. Contact Early Years Scotland for additional forms Postcode... Morning Afternoon Evening Please show the operating hours of your Setting (e.g ; ; ) Monday Tuesday Wednesday Thursday Friday Is your Setting registered with the Care Inspectorate? Yes No Does your Setting have charitable status? Yes No Does your Setting receive partnership funding from your local authority? Yes No Is your Setting a company limited by guarantee? Yes No Is your Setting a SCIO? Yes No Is your group operated by a voluntary management committee; is it privately owned; or is it local authority run? Voluntary Management Privately Local Authority Committee Owned Run Q6: Where did you hear about Early Years Scotland? Early Years Scotland staff Early Years Scotland website Another Early Years Scotland member group Local Authority Childcare Information Service Local Authority Early Years Staff Care Inspectorate Other (please specify)...

4 Q7: Insurance Section For Settings that only require membership, please DO NOT complete the following insurance details. Go straight to question 8. NOTE: In order to access the specially negotiated insurance scheme, Settings must be Early Years Scotland members. All policies are arranged by Mackay Corporate Insurance Brokers and underwritten by Royal & Sun Alliance Insurance plc. This insurance provides you with your insurance requirements under one cover. (See next page for details of the Buildings Cover and Enhanced Business Interruption Insurance). Please read the enclosed summary of insurance booklet. The basic premium gives a sum insured of 5,000 for your equipment. Your Setting should have an inventory of all the equipment it owns. Please consider what it would cost to replace everything. The level of sum insured should reflect the full replacement value, if it does not then an under insurance clause may apply to your claim e.g. if replacement value is 10,000 but you have insured it for 5,000 any claim settlement for contents will be reduced by 50%. If your Setting requires more than 5,000 sum insured, this can be increased in bands of 1,000 under the section extra equipment cover. Cover At a Glance Equipment (Basic Sum Insured 5,000) Personal Effects (Sum Insured 75) Fire Perils and Theft Legal Advice Public Liability - 5m Breakage of Glass Employers Liability Loss of Money Personal Accident Personal Injury Robbery Accidental Damage Frozen Food Premium Costings Premium Amount Out of School Care Childcare Settings 0-5 years, session lasting 0-4 hours Childcare Settings 0-5 years, session lasting 4-6 hours Childcare Settings 0-5 years, session lasting over 6 hours Childcare Settings where children under two are attending without a parent or carer Playscheme/Crèche (session up to 4 hours) Playschemes or Crèches where children under the age of 2 years are unaccompanied, the insurance premium of is payable. Total value of equipment (including the first 5,000 which is covered automatically): Example: If your group has 8,000 worth of equipment the additional premium would be Extra equipment per additional 1,000 or part thereof 4.50 Optional Extras Increased Limit of Indemnity under Public Liability up to 10 million Directors and Officers Liability 250,000 limit ,000 limit Professional Indemnity 100,000 limit ,000 limit ,000 limit m limit Business Interruption (additional cost of working up to 25,000 cover) (See overleaf for more extensive Business Interruption Cover) Should your group select to insure a package of optional extensions the following rates apply: Enhanced Package Rates Cover Bronze Silver Gold Public Liability 5m 5m 10m - 79 Business Interruption 25K *ACOW K *ACOW K *GP Professional Indemnity 100K K K - 80 Directors and Officers 250K K K Total Cost Discount 7.5% 10% 12.5% Net Cost *ADDITIONAL COST OF WORKING/GROSS PROFIT

5 Insurance Optional Extras (continued) All Risks Cover for video/camera equipment, mobile telephones and 3.00 per 100 computer equipment whilst away from Setting premises. Please note there or part thereof is a 50 excess on All Risks Cover Please note all the following details must be given for All Risks Cover (continue on a separate sheet if necessary) : All Risks item: Make Model Serial number Value of each piece of Equipment APPLICATION FOR CHILD PROTECTION (ABUSE) COVER To be completed by Chairperson, Authorised Office Bearer, Owner or Authorised Signatory only This cover relates to acts of abuse to children when in the care of the group. Although we usually associate abuse as something physical it does go further than that and includes mental injury. Abuse is defined as meaning: i) acts of hurting or injuring mentally by maltreatment or ill-use ii) acts of forcing sexual activity upon or rape or molestation or iii) repeated or continuing contemptuous coarse or insulting words or behaviour. To be eligible to purchase Child Protection (Abuse) cover your Group needs to comply with all of the undernoted statements. Group means any member or group associate member of Early Years Scotland as defined in the Early Years Scotland Membership and Insurance Application Forms. Please note that any misrepresentation may invalidate your insurance cover. 1. Your Group has a written Child Protection Policy. 2. Your Group has a designated person responsible for all issues regarding the protection of children. 3. Your Group has guidelines on intimate care or appropriate contact with children. 4. Your Group has undertaken Disclosure checks or has ensured that the relevant Protecting Vulnerable Groups Scheme Record is in place for all Employees and Volunteers in accordance with the PVG Scheme prior to employment. 5. Your Group has undertaken refresher Disclosure checks at least once every three years or ensures the relevant Scheme Record made in accordance with the Protecting Vulnerable Groups Scheme is in place for existing Employees and Volunteers, this includes parents on rota duty. Continued over...

6 6. All prospective Employees and Volunteers are required to declare prior abuse convictions and whether they have been the subject of any investigation or enquiry into abuse or other inappropriate behaviour. 7. No Employee or Volunteer past or present has ever been interviewed in connection with or been the subject of any investigation or enquiry into abuse or other inappropriate behaviour. 8. Your Group record the receipt including signature by Employees and Volunteers of all your policy procedures and guidelines. 9. All Employees and Volunteers receive relevant training in the protection of children. 10. If registered with the Care Inspectorate your Group do not have any outstanding requirements following their last inspection of your Group. DECLARATION I/we declare that to the best of my/our knowledge and belief our Group complies with all the above statements which form the basis upon which Royal & Sun Alliance Insurance plc provide our Child Protection (Abuse) insurance cover and that this statement of fact shall be incorporated in and form part of the insurance contract. ONLY SIGN BELOW IF YOUR GROUP REQUIRE CHILD PROTECTION COVER. Signature To be signed by Chairperson, Authorised Office Bearer, Owner or Authorised Signatory only. Name (please print) Position in Organisation (please print) This cover has a limit of 1,000,000 CHILD PROTECTION (ABUSE COVER) PREMIUMS Type of Group (this should be the same as the front page of this form) Premium (tick appropriate box and add to your insurance total in Question 9). All Premiums include Insurance Premium Tax at the current rate. Out of School Care 131 Childcare Setting, 0-4 hours 36 Childcare Setting, 4-6 hours 110 Childcare Setting, over 6 hours 110 Playscheme, 0-4 hours 36 Crèche, 0-4 hours 36 Above groups where children under two are unaccompanied 110 Above groups with out of school care facility 131 All premiums include Insurance Premium Tax at the current rate Total amount due

7 A Buildings Cover Scheme is available if you own your premises. Buildings should be of standard construction, e.g. built of brick or stone with slate or tiled roofs. See the Summary of Insurance brochure for more details. Please tick if you would like further details of this package A more comprehensive Business Interruption Insurance is also available which will pay for gross profit and additional cost of working. This may be more applicable to Settings operating in a profit making capacity. See the Summary of Insurance brochure for more details. Please tick if you would like further details of this package PAYE Reference Number The Government requires all UK businesses that employ staff to provide them with details of their PAYE number (i.e. 952/ ). This number is the reference number for employer s income tax and national insurance contributions. Please complete: PAYE Reference no... Even if you do not employ any staff or all your employees are paid below the employer national insurance threshold limit or have no income tax deducted from their monthly payslip we are required to submit this information to our insurers. Therefore, if this is the case please tick this box in order that we may note our records accordingly Q8: Data Protection Early Years Scotland occasionally releases group details to a limited number of approved firms and organisations whose products or services may be of interest to Early Years Scotland groups. To comply with data protection legislation, the contact person must indicate if they are willing for their name to be released. Please tick if you have no objection to your name being released by Early Years Scotland to approved firms and organisations All personal information supplied by you will be treated in confidence by Mackay Corporate Insurance Brokers and Royal & Sun Alliance Insurance plc and will not be disclosed to any third parties except where your consent has been received or where permitted by law. In order to provide you with products and services this information will be held in data systems of Royal & Sun Alliance Insurance plc or our agents or subcontractors. Royal & Sun Alliance Insurance plc may pass your personal data to other Companies for processing on its behalf. Some of these companies may be based outside Europe in countries which may not have laws to protect your personal data, but in all cases the Group will ensure that it is kept securely and only used for the purposes for which you provided it. Details of the companies and countries involved can be provided to you on request. Q9: Final Amount (1) Membership amount sent (The amount ticked in question 4) (2) Insurance amount sent (As detailed in question 7. Include Child Protection [Abuse] Cover if applicable.) = Total (1) + (2) (Please make sure the payment amount corresponds with this figure) Please make out ONE cheque or postal order to cover the full amount, made payable to Early Years Scotland Membership. Payment can also be made via credit/debit card by phoning Early Years Scotland on or by bank transfer (BACS). Our sort code is and our account number is Changes to your circumstances: You must tell us about any changes that happen after your policy is arranged. If you are in any doubt about whether facts are material, you must tell us failure to do so could affect the validity of your policy. I/We declare to the best of my/our knowledge and belief that the statements in the insurance section are true and complete and will form part of the contract between me/us and the Insurer. Signature of chair, other office bearer, owner or authorised signatory Name and position in organisation in block capitals please Name: Position: PLEASE NOTE WE ARE UNABLE TO PROCESS THIS APPLICATION UNLESS IT IS SIGNED. The chairperson, other office bearer, owner or authorised signatory should sign on behalf of the group to apply for membership, and insurance if required. This person s name will be entered onto the company s membership list on behalf of the group. Any change to the named person must be notified to Early Years Scotland in writing or via . Notwithstanding acceptance of the membership criteria, Early Years Scotland has the right to refuse any application for membership.the parties to the Policy have the right to choose the law applicable to the Policy. Unless the parties agree otherwise in writing any dispute concerning the interpretation of this Proposal or the Policy shall be governed and construed in accordance with English law and shall be resolved within the non-exclusive jurisdiction of the courts of England and Wales.

8 When your form is completed, please return it, along with your cheque, to: Early Years Scotland, GRANVILLE STREET, GLASGOW, G3 7EE. Please keep a photocopy of this form for your group s records. CHECKLIST! Have you enclosed...? This form duly completed Please tick appropriate payment box : Cheque Credit/Debit Card BACS Have you signed the application form? (It is a legal requirement that you do so) Have you signed the Child Protection Form where applicable? FOR OFFICIAL USE ONLY: Date Received: Date Returned: Checked by: Reason for Return: Process Finalised: Early Years Scotland supports community based early education and childcare services for children and families. Early Years Scotland is a company limited by guarantee, registered in Scotland No 86932: registered office at Granville Street, Glasgow G3 7EE. Early Years Scotland is a Scottish Charity (SC003725). Insurance arranged by MacKay Corporate Insurance (No ) 38 Miller Road, Ayr, KA7 2AY. Authorised and regulated by the Financial Conduct Authority. Underwritten by Royal & Sun Alliance Insurance plc (No ). Registered in England and Wales at St Mark s Court, Chart Way, Horsham, West Sussex, RH12 1XL. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority

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