Early Years Scotland Group Associate
Membership & Insurance Application Form
1 April 2015 - 31 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 0141 221 4148. 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
Q3: Name, Address, e-mail 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
email, 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 email 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. ............................................................................... email .........................................................................................................................................
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
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 email .....................................................................................................................
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 .......................................................
Please show the operating hours of your Setting
Monday
(e.g 9.30-12.30; 1.30-4.30; 5.00-7.00)
Tuesday
Afternoon
Morning
Evening
Wednesday
Thursday
Friday
Is your Setting registered with the Care Inspectorate? Yes
Does your Setting have charitable status?
Yes
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?
No
No
Voluntary Management Privately
Local Authority
Run
Owned
Committee
Q6: Where did you hear about Early Years Scotland?
Early Years Scotland staff Early Years Scotland website
Local Authority Childcare Information Service
Another Early Years Scotland member group
Local Authority Early Years Staff
Care Inspectorate
Other (please specify) ...............................................................................................................................................................................................................
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 GlassEmployers’ LiabilityLoss of Money
Personal AccidentPersonal Injury RobberyAccidental DamageFrozen Food
Premium Costings
Premium
Amount
Out of School Care £354.00
£
Childcare Settings 0- 5 years, session lasting 0-4 hours
£111.00
£
Childcare Settings 0- 5 years, session lasting 4-6 hours
£211.00
£
Childcare Settings 0- 5 years, session lasting over 6 hours
£134.00
£
Childcare Settings where children under two are attending without a parent or carer
£354.00
£
Playscheme/Crèche (session up to 4 hours)
Playschemes or Crèches where children under the age of 2 years are unaccompanied,
the insurance premium of £320.00 is payable.
£77.00
£
£4.50
£
Increased Limit of Indemnity under Public Liability up to £10 million
£79.00
£
Directors and Officers Liability
£
£80.00
£
£106.00
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 £13.50.
£
Extra equipment per additional £1,000 or part thereof
Optional Extras
£250,000 limit
£500,000 limit
Professional
Indemnity £100,000 limit
£250,000 limit
£500,000 limit
£1m limit
Business Interruption (additional cost of working up to £25,000 cover). (See overleaf for more extensive Business Interruption Cover)
£53.00
£80.00
£127.00
£160.00
£21.00
£
£
£
£
£
Should your group select to insure a package of optional extensions the following rates apply:
Enhanced Package Rates
Cover
Bronze
Silver
Public Liability
£5m £5m Business Interruption
£25K *ACOW - £21
£25K *ACOW - £21
£250K *GP - £100
Professional Indemnity
£100K - £53
£250K - £80
£250K - £80
Directors and Officers
£250K - £80
£500K - £106
Total Cost
£154
£207
£365
Discount
7.5%
10%
12.5%
Net Cost
£142
£186
£319
*ADDITIONAL COST OF WORKING/GROSS PROFIT
Gold
£10m - £79
£500K - £106
Insurance Optional Extras (continued)
All Risks Cover for video/camera equipment, mobile telephones and £3.00 per £100
or part thereof
computer equipment whilst away from Setting premises. Please note there
£
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. 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.
Position in
Organisation
(please print)
Name
(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 £
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. 952/7829273).
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)
Total (1) + (2)
£
=
(2) Insurance amount sent (As
detailed in question 7. Include Child
£
Protection [Abuse] Cover if applicable.)
£
(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 0141 221 4148 or by bank transfer
(BACS). Our sort code is 80-07-60 and our account number is 00733700.
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 email. 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.
When your form is completed, please return it, along with your cheque, to: Early Years
Scotland, 21-23 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
Have you signed the application form? (It is a legal requirement that you do so)
Have you signed the Child Protection Form where applicable?
Credit/Debit Card
BACS
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 21-23 Granville Street, Glasgow G3
7EE. Early Years Scotland is a Scottish Charity (SC003725).
Insurance arranged by MacKay Corporate Insurance (No. 114821) 38 Miller Road, Ayr, KA7 2AY. Authorised and regulated by the Financial
Conduct Authority.
Underwritten by Royal & Sun Alliance Insurance plc (No. 93792). 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