After School Care Registration Form

Your information

Name of Child* Class* Name of Parent/Carer 1* Contact Number* Address* Name of Parent/Carer 2* Contact Number* Address

Emergency Contact Details

Name - Emergency Contact 1* Emergency Contact 1 - Contact Number* Emergency Contact 1 - Address* Relationship to child* Name - Emergency Contact 2* Emergency Contact 2 - Contact Number* Emergency Contact 2 - Address* Relationship to child* Please provide a password for alternative contacts to use when collecting children

Medical Information

Please give details of any known medical conditions Please give details of any known food allergies or dietary requirements:

I consent to staff seeking emergency medical treatment of my child during the club*YesNo

Please indicate which day/s sessions you would like your child to attend

Starting From* Monday* Tuesday* Wednesday* Thursday* Friday*

Booking Type*Single BookingEvery Week

Declaration

I have read and understood the information pack. please register my child for Extended School Club*I agree please register