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After School Care Registration Form
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
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Emergency Contact Details
Name - Emergency Contact 1
*
Emergency Contact 1 - Contact Number
*
Emergency Contact 1 - Address
*
Relationship to child
*
Aunt
Uncle
Grandparent
Family Friend
Name - Emergency Contact 2
*
Emergency Contact 2 - Contact Number
*
Emergency Contact 2 - Address
*
Relationship to child
*
Aunt
Uncle
Grandparent
Family Friend
Please provide a password for alternative contacts to use when collecting children
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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
*
Yes
No
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Please indicate which day/s sessions you would like your child to attend
Starting From
*
Monday
*
none
Full session 3:00pm - 5:00pm £7.00
Part session 3:00pm - 4:00pm £3.50
Part session 4:00pm - 5:00pm £3.50
Tuesday
*
none
Full session 3:00pm - 5:00pm £7.00
Part session 3:00pm - 4:00pm £3.50
Part session 4:00pm - 5:00pm £3.50
Wednesday
*
none
Full session 3:00pm - 5:00pm £7.00
Part session 3:00pm - 4:00pm £3.50
Part session 4:00pm - 5:00pm £3.50
Thursday
*
none
Full session 3:00pm - 5:00pm £7.00
Part session 3:00pm - 4:00pm £3.50
Part session 4:00pm - 5:00pm £3.50
Friday
*
none
Full session 3:00pm - 5:00pm £7.00
Part session 3:00pm - 4:00pm £3.50
Part session 4:00pm - 5:00pm £3.50
Booking Type
*
Single Booking
Every Week
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Declaration
I have read and understood the information pack. please register my child for Extended School Club
*
I agree please register
Please rate the following
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